Robotic systems, devices, and methods for vascular access

ABSTRACT

An apparatus for vascular access is described herein. The apparatus can comprise a cart movable from a first location to a second location near a patient, a manipulating device configured to releasably couple a cartridge including a needle, a catheter, and a guidewire that are coaxially disposed with respect to each other, and a robotic arm having a first end mounted to the cart and a second end coupled to the manipulating device. The manipulation device can include a plurality of actuation mechanisms configured to selectively advance the needle, the catheter, and the guidewire when the manipulating device is coupled to the cartridge. The robotic arm can include a plurality of joints that are configured to rotate about a plurality of axes to position the cartridge relative to the arm of the patient such that the needle, the catheter, and the guidewire can be inserted into a target vessel of the patient.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to and benefit of U.S. ProvisionalApplication No. 63/236,537, entitled “ROBOTIC SYSTEMS, DEVICES, ANDMETHODS FOR VASCULAR ACCESS,” filed Aug. 24, 2021, the disclosure ofwhich is incorporated herein in reference in its entirety.

TECHNICAL FIELD

The present disclosure relates generally to robotic systems, devices,and methods for vascular access. More specifically, the presentdisclosure relates to robotic systems, devices, and methods forpositioning a needle and/or catheter into a blood vessel of a subject.

BACKGROUND

Interventional medical procedure is a popular procedure that candiagnose and treat diseases in various organs of a patient.Interventional medical procedures are minimally-invasive image guidedmedical procedures that minimize risk to the patient in comparison toopen surgeries.

In order to perform an interventional medical procedure on the vascularsystem, an operator may need to gain safe access to one or more bloodvessels. Traditionally, sharp trocars were used access blood vessels.Trocars can be used to create lumens through which a catheter can beeventually inserted. However, there are several drawbacks associatedwith trocars. For instance, improperly placed trocars can lead tovarious complications such as organ injury, hemorrhage, failed access,catheter malposition, infection, etc.

More recently, the Seldinger technique has been widely employed in orderto gain safe access to the vascular system. The Seldinger techniqueinvolves puncturing a desired blood vessel with a needle. A guidewire isinserted through the needle such that the guidewire is placed into theblood vessel. Once the guidewire has advanced to the desired lengthand/or location in the blood vessel, the needle is removed. A catheteris then advanced into the blood vessel over the guidewire. Once thecatheter is in the blood vessel, the guidewire is pulled out. TheSeldinger technique has fewer complications in comparison to usingtrocars.

However, the Seldinger technique often requires an experienced surgeonand/or operator to perform the technique on a patient. For instance,human errors made by a surgeon and/or an operator while inserting theguidewire through the needle, or advancing the guidewire to the desiredlocation in the blood vessel can cause complications such as vesselperforation, pseudoaneurysm formation, hemorrhage, infection, etc.Therefore, human errors and inconsistencies while performing theSeldinger technique can cause failures and lead to complications.

Accordingly, there is an unmet need to provide guidance to operatorswhile inserting a needle and/or catheter into a patient to gain safevascular access and to improve consistency and reduce complications thatmay arise due to human errors.

SUMMARY

Robotic system, devices, and methods for vascular access are describedherein. In some embodiments, an apparatus comprises a cart, amanipulation device, and a robotic arm. The cart can be movable from afirst location to a second location near a patient. The cart can have aplatform configured to support an arm of the patient. The manipulationdevice can be configured to releasably couple a cartridge including aneedle, a catheter, and a guidewire that are coaxially disposed withrespect to each other. The manipulation device can include a pluralityof actuation mechanism configured to selectively advance the needle, thecatheter, and the guidewire when the manipulation device is coupled tothe cartridge. The robotic arm can have a first end mounted on the cartand a second end coupled to the manipulation deice. The robotic arm caninclude a plurality of joints that are configured to rotate about aplurality of axes to position the cartridge relative to the arm of thepatient such that the needle, the catheter, and the guidewire can beinserted into a target blood vessel of the patient.

In some embodiments, an apparatus comprises a cartridge including aguidewire, a needle, and a catheter. The guidewire can be configured tocouple to a first linear actuator moveable along a first axis to advancethe guidewire. The needle can be configured to couple to a second linearactuator moveable along a second axis to advance the needle. Thecatheter can be configured to couple to a third linear actuator moveablealong a third axis to advance the catheter. The guidewire, the needle,and the catheter can be arranged coaxially with the guidewire disposedwithin a lumen of the needle and the needle being disposed within alumen of the catheter.

In some embodiments, a method comprises advancing a tip of a needle intoa target vessel using a first linear actuator of a manipulating device.The method also includes advancing a tip of a guidewire using a secondlinear actuator of the manipulation device such that the tip of theguidewire extends distally from the tip of the needle. After advancingthe tip of the guidewire, the method comprises advancing a tip of acatheter using a third linear actuator of the manipulation device suchthat the tip of the catheter extends distally from the tip of theneedle. The catheter can include a catheter hub that is releasablycoupled to the manipulation device. After advancing the tip of thecatheter the method comprises releasing the catheter from themanipulating device.

In some embodiments, an apparatus comprising a cart movable from a firstlocation to a second location near a patient, a manipulation deviceconfigured to releasably couple to a cartridge including a needle, acatheter, and a guidewire that are coaxially disposed with respect toeach other, and a robotic arm having a first end mounted to the platformand a second end coupled to the manipulation device. The cart can have aplatform and a vertical adjustment element configured to adjust adistance between the platform and a ground supporting the cart. Themanipulation device can include a plurality of actuators each configuredto couple to a different one of the needle, the catheter, and theguidewire to selectively advance the needle, the catheter, and theguidewire, when the manipulation device is coupled to the cartridge. Therobotic arm can have a plurality of segments joined together via aplurality of joints such that the robotic arm can be moved to positionthe needle, the catheter, and the guidewire for insertion into a targetvessel.

In some embodiments, the apparatus can further comprise an imagingsystem coupled to a distal end portion of the manipulation device. Theimaging system can be configured to capture a traverse view and alongitudinal view each including the target vessel. In some embodiments,the imaging system can be configured to change the traverse view as atip of the needle is advanced into the target vessel to show thetransverse view that corresponds to a transverse plane of the tip of theneedle. In some embodiments, the imaging system can include anultrasound array.

In some embodiments, the manipulation device can include a couplingmechanism coupled to one of the plurality of actuators. The couplingmechanism can be configured to releasably couple to a coupling elementin the cartridge that is coupled to at least one of the needle, thecatheter, or the guidewire, such that, upon the coupling mechanism beingcoupled to the coupling element, movement of the actuator causes arespective movement of the at least one of the needle, the catheter, andthe guidewire. In some embodiments, the coupling mechanism can includeat least one magnet, and the coupling element can include at least onemagnetic element. The at least one magnet can be configured tomagnetically couple to the at least one magnetic element. In someembodiments, the manipulation device can include at least one sensor todetect the coupling between the coupling mechanism of the manipulationdevice and the coupling element in the cartridge. In some embodiments,the at least one sensor can include a Hall Effect sensor, and themanipulation device can further include a permanent magnet that isconfigured to displace in response to the coupling between the couplingmechanism and the coupling element. The Hall Effect sensor can beconfigured to measure a change in a magnetic field intensity caused bythe movement of the permanent magnet.

In some embodiments, the manipulation device can be pivotably supportedby a joint of the plurality of joints with respect to a distalmostsegment of the robotic arm such that an angle of insertion of theneedle, the catheter, and the guidewire into the target vessel can beadjusted via the joint. In some embodiments, a center of mass of themanipulation element can be disposed near the joint to reduce torque dueto gravity on the joint. In some embodiments, each joint of theplurality of joints of the robotic arm can include a failsafe brakeconfigured to lock movement about the joint until electrically released.

In some embodiments, the apparatus can further comprise an imagingsystem configured to capture a view including at least a part of themanipulating device and a portion of the patient including the targetvessel, and a communication interface configured to send image data ofthe view to a remote compute device such that a position of thecartridge relative to the portion of the patient can be confirmed by auser at the remote compute device.

In some embodiments, an apparatus can comprise a cartridge including aguidewire, a needle, and a catheter that are coaxially disposed withrespect to each other, and a plurality of guides coupled to theguidewire, the needle, and the catheter. The apparatus can also comprisea manipulation device including a plurality of actuators each configuredto couple to a different guide member of the plurality of guides. Theplurality of actuators can be configured to linearly advance and retractthe plurality of guides to move the needle, the guidewire, and thecatheter. The apparatus can also comprise a control unit operativelycoupled to the manipulation device. The control unit can be configuredto control the plurality of actuators to selectively move the needle,the guidewire, and the catheter to gain access via the catheter to atarget vessel of a patient.

In some embodiments, the plurality of actuators can include: a firstlinear actuator configured to linearly advance and retract a first guideof the plurality of guides to move the guidewire, a second linearactuator configured to linearly advance and retract a second guide ofthe plurality of guides to move the needle, and a third linear actuatorconfigured to linearly advance and retract a third guide of theplurality of guides to move the catheter. In some embodiments, themanipulation device further can include a plurality of shafts supportingthe first linear actuator, the second linear actuator, and the thirdlinear actuator. In some embodiments, the plurality of shafts caninclude a first shaft supporting the first linear actuator and thesecond linear actuator, and a second shaft supporting the third linearactuator. In some embodiments, the plurality of shafts can include afirst shaft supporting the first linear actuator, a second shaftsupporting the second linear actuator, and a third shaft supporting thethird linear actuator.

In some embodiments, the manipulation device can include a plurality ofrecessed portions. Each recessed portion of the plurality of recessedportions can be configured to receive a respective guide member of theplurality of guides. In some embodiments, each actuator of the pluralityof actuators can include a magnet configured to magnetically couple thatactuator with a respective one of the plurality of guides. In someembodiments, each guide of the plurality of guides can include amagnetic portion configured to magnetically couple to the magnet of therespective actuator coupled to that guide. In some embodiments, eachactuator of the plurality of actuators can include a sensor configuredto detect a coupling between the magnet of that actuator with therespective coupling element. In some embodiments, the cartridge can beconfigured to store the guidewire in a linear state.

In some embodiments, an apparatus can comprise a cartridge configured tocouple to a manipulation device of a robotic system for providing accessto a target vessel of a patient. The cartridge can include: a housing, aguidewire disposable at least partially within the housing andconfigured to couple to a first linear actuator of the manipulationdevice that is moveable along a first axis to advance the guidewire, aneedle disposable at least partially within the housing and configuredto couple to a second linear actuator of the manipulation device that ismoveable along a second axis to advance the needle, and a catheterconfigured to couple to a third linear actuator of the manipulationdevice that is moveable along a third axis to advance the catheter. Theguidewire, the needle, and the catheter can be arranged coaxially withthe guidewire being disposed within a lumen of the needle and the needlecan be disposed within a lumen of the catheter.

In some embodiments, the cartridge can further comprise a first guidecoupled to the guidewire and configured to couple to the first linearactuator, a second guide coupled to the needle and configured to coupleto the second linear actuator, and a third guide releasably coupled tothe catheter and configured to couple to the third linear actuator. Insome embodiments, the first guide can include a first coupling elementconfigured to couple the first guide to the first linear actuator, thesecond guide can include a second coupling element configured to couplethe second guide to the second linear actuator, and the third guide caninclude a third coupling element configured to couple the third guide tothe third linear actuator.

In some embodiments, the first, second, and third coupling elements caninclude magnetic portions that are configured to engage with a magnet ofrespective ones of the first, second, and third linear actuators. Insome embodiments, the housing can include features configured to fit inslots in the manipulation device to mechanically couple the housing tothe manipulation device.

In some embodiments, a method can comprise advancing, using a firstlinear actuator of a robotic system, a tip of a needle into a targetvessel. The needle can be coaxially disposed with a catheter and aguidewire. The method can also comprise advancing, using a second linearactuator of a robotic system, a tip of the guidewire through a lumen ofthe needle such that the tip of the guidewire extends distally from thetip of the needle. After advancing the tip of the guidewire, the methodcan comprise advancing, using a third linear actuator of the roboticsystem, a tip of the catheter over at least a portion of the guidewiresuch that the tip of the catheter extends into the target vessel. Thecatheter can include a catheter hub that is releasably coupled to thethird linear actuator via a guide. After advancing the tip of thecatheter, the method can also comprise retracting, using the first andsecond linear actuators, the needle and the guidewire from the targetvessel.

In some embodiments, the method can further comprise decoupling, afteradvancing the tip of the catheter hub from the guide so that thecatheter is decoupled from the robotic system. In some embodiments, thefirst, second, and third linear actuators are disposed in a manipulationdevice mounted to a robotic arm of the robotic system. The method canfurther comprise rotating at least one joint of the robotic arm toposition the manipulation device at a predetermined acute angle relativeto a longitudinal axis of a target vessel.

Other systems, processes, and features will become apparent to thoseskilled in the art upon examination of the following drawings anddetailed description. It is intended that all such additional systems,processes, and features be included within this description, be withinthe scope of the present invention, and be protected by the accompanyingclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

The skilled artisan will understand that the drawings primarily are forillustrative purposes and are not intended to limit the scope of theinventive subject matter described herein. The drawings are notnecessarily to scale; in some instances, various aspects of theinventive subject matter disclosed herein may be shown exaggerated orenlarged in the drawings to facilitate an understanding of differentfeatures. In the drawings, like reference characters generally refer tolike features (e.g., functionally similar and/or structurally similarelements).

FIG. 1 is a block diagram that illustrates a system for facilitatingvascular access, according to some embodiments.

FIG. 2 a block diagram that illustrates a system for facilitatingvascular access, according to some embodiments.

FIG. 3 is a block diagram the illustrates a robotic arm of a system forfacilitating vascular access, according to some embodiments.

FIG. 4 is a block diagram the illustrates a base of a system forfacilitating vascular access, according to some embodiments.

FIG. 5 is a block diagram the illustrates components of a manipulationdevice and a cartridge assembly and interactions therebetween, accordingto some embodiments.

FIG. 6 is a flow diagram illustrating a method of performing a vascularaccess procedure, in accordance with some embodiments.

FIG. 7 is a flow diagram illustrating a method of using a vascularaccess system to perform the Seldinger technique, in accordance withsome embodiments.

FIG. 8 is a flow diagram illustrating a method of using visual aidand/or sensor data to perform a vascular access procedure, in accordancewith some embodiments.

FIG. 9A illustrates a vascular access system, in accordance with someembodiments.

FIG. 9B illustrates a vascular access system, in accordance with someembodiments.

FIG. 10 illustrates an example stereo camera array to capture imagedata, in accordance with some embodiments.

FIG. 11A illustrates an example robotic system, in accordance with someembodiments.

FIG. 11B illustrates rotational motion and vertical movement for a base,in accordance with some embodiments.

FIGS. 12A-12C illustrates a robotic arm, in accordance with someembodiments.

FIG. 13A illustrates a first proximal axis of the robotic arm along armsupport that enables vertical translation of the robotic arm along thearm support, in accordance with some embodiments.

FIG. 13B illustrates a mass-over-pulley system that enables verticaltranslation of a robotic arm, in accordance with some embodiments.

FIG. 14 illustrates a manipulation device, in accordance with someembodiments.

FIG. 15 illustrates a traverse view and a longitudinal view of a bloodvessel as captured by an ultrasound imaging device, in accordance withsome embodiments.

FIGS. 16A-16D illustrate a change in the active transverse elements of atwo-dimensional ultrasound array as a tip of the needle advances intothe blood vessel, in accordance with some embodiments.

FIG. 17 illustrates a manipulation device, in accordance with someembodiments.

FIG. 18 is an illustration of a linear actuator within the manipulationdevice that can actuate the needle, the catheter, and/or the guidewire,in accordance with some embodiments.

FIG. 19A illustrates a cartridge assembly, in accordance with someembodiments.

FIG. 19B is an exploded view of a cartridge assembly, in accordance withsome embodiments.

FIGS. 20A and 20B illustrate attaching and/or coupling a cartridgeassembly to a manipulation device, in accordance with some embodiments.

FIG. 21A illustrates a puck included in the cartridge assembly, inaccordance with some embodiments.

FIG. 21B illustrates a coupling between a manipulation device and acartridge assembly, in accordance with some embodiments.

FIGS. 22A and 22B illustrate a mechanism to detect a coupling between apermanent electromagnet in a manipulation device and a puck in acartridge assembly, in accordance with some embodiments.

FIGS. 23A and 23B illustrate the anatomical positioning of themanipulation device with respect to a blood vessel, in accordance withsome embodiments.

FIGS. 24A-24F illustrate the steps of the Seldinger technique performedusing a manipulation device and a cartridge assembly, in accordance withsome embodiments.

FIG. 25 is a table illustrating the states of the needle actuator,catheter actuator, and guidewire actuator for the Seldinger technique,in accordance with some embodiments.

FIG. 26 illustrates another variation of a manipulation device, inaccordance with some embodiments.

FIGS. 27A and 27B illustrate different views of the manipulation deviceshown in FIG. 26 , in accordance with some embodiments.

FIG. 28 is an illustration of a linear actuator within the manipulationdevice in FIG. 26 that can actuate the needle, the catheter, and/or theguidewire, in accordance with some embodiments.

FIGS. 29A and 29B are an illustration of a cartridge assembly thatattaches to the manipulation device in FIG. 26 , in accordance with someembodiments.

DETAILED DESCRIPTION

Robotic systems, devices, and methods for vascular access are describedherein. In some embodiments, the robotic systems, devices, and methodsdescribed herein automate or semi-automate vascular access (e.g., theprocedure of the Seldinger technique) in order to provide safe access toblood vessel(s) and/or organ(s). The blood vessel(s) can be any suitabletype of blood vessel(s) such as arteries (e.g., radial artery, femoralartery, etc.), veins (e.g., brachial vein, basilic vein, cephalic vein,femoral vein, internal jugular vein, median cubital vein, medianantebrachial vein, etc.).

In some embodiments, the technology described herein includes a roboticsystem for facilitating vascular access. The robotic system can includea manipulation device. The manipulation device can comprise or otherwisebe attached to a guidewire, a needle, and a catheter that is to bepositioned in a blood vessel of a subject. The robotic system and themanipulation device can be controlled by a user (e.g., an operator, asurgeon, etc.) using one or more input/output (I/O) devices. In someembodiments, the manipulation device can include an imaging device(e.g., an ultrasound array). The imaging device can provide the userwith visual aid (e.g., ultrasound images of the blood vessel) of theprocedure such as the guidewire, the needle, and/or the catheter beinginserted into a blood vessel. In some embodiments, the I/O device(s) caninclude a sensor (e.g., camera) that provides feedback (e.g., image dataof the robotic system, manipulation device, and/or portion of asubject's body) to the robotic system as the manipulation deviceaccesses a blood vessel. The robotic system can adjust the movement,position, and/or orientation of the guidewire, needle, and/or catheterbased on data from the sensor so as to automate the procedure ofvascular access. In some embodiments, the user can remotely control therobotic system and/or the manipulation device to perform the procedurebased on the data from the sensor and the visual aid from the imagingdevice. Further details of such a system are described below withreference to the figures.

Vascular Access System and Components

FIG. 1 is a high-level block diagram that illustrates a system 100,according to some embodiments. System 100 can be configured to automateand/or semi-automate a medical procedure for vascular access. System 100includes a robotic system 102 including a manipulation device 130. Therobotic system 102 and/or the manipulation device 130 can becommunicably coupled to one or more I/O device(s) 104 (e.g., externaland/or remote I/O devices). In some embodiments, the robotic system 102and/or the manipulation device 130 can be optionally communicablycoupled to one or more sensor(s) 106 (e.g., external and/or remotesensors).

In some embodiments, the robotic system 102 can be any suitable robot.For instance, the robotic system 102 can include a robotic arm that canform a part of a robotic device. The robotic device itself can be anautonomous and/or a semi-autonomous cart coupled to and/or integratedwith the manipulation device. In some embodiments, the robotic devicecan include a base with a flat portion that is configured to support apatient on whom the medical procedure is to be performed as furtherdescribed herein. Alternatively, the robotic device can be an autonomousrobot with humanoid features (e.g., arms, transport elements, head,base, etc.).

The robotic system 102 can include a robotic arm with two or moresegments coupled together via joints, as further detailed with referenceto FIG. 3 . Joints can allow one or more degrees of freedom. Forexample, joints can provide for translation along and/or rotation of therobotic arm about one or more axes. In some embodiments, one end segmentof the robotic arm can include a coupling element. The coupling elementcan couple the robotic arm to the manipulation device 130. The other endsegment of the robotic arm can be disposed on, affixed to, mounted on,and/or integrated with at least a portion of the robotic system 102.

In some embodiments, the robotic arm can be disposed on, affixed to,mounted on, and/or integrated with a base (e.g., base of an autonomousand/or semi-autonomous cart) of the robotic system 102, as furtherdetailed with reference to FIG. 2 . In some embodiments, the base cancarry the robotic arm, one or more I/O device(s) 104, and one or moresensor(s) 106. The base can be a movable base with one or more transportelements that can provide for translation along and/or rotation of therobotic system 102 along one or more axes. Additionally oralternatively, the base can be configured to be stationary. In someembodiments, the base can be configured to raise vertically so as toposition the robotic arm at an appropriate height with respect to asubject (e.g., a patient on whom the medical procedure is to beperformed). In some embodiments, the base can include a lockingmechanism to lock the movement of the transport elements and/or themovement of the base itself.

In some embodiments, the robotic system 102 can include a communicationinterface to enable communication with the I/O device(s) 104 and/or thesensor(s) 106. In some embodiments, the robotic system 102 can include acontrol unit to control the robotic system 102 (e.g., to control thebase, robotic arm, etc.).

The robotic system 102 is described as a robotic arm disposed on,affixed to, mounted on, and/or integrated with a base solely forillustrative purposes. It should be readily understood that the roboticsystem 102 can be any suitable robotic component (e.g., robotic cart,humanoid robot, etc.) that can be coupled to one or more manipulationdevices 130. For instance, the robotic system 102 can include multiplerobotic arms that form a part of the robotic system 102. Each roboticarm can be coupled to a respective manipulation device. In such ascenario, the robotic system 102 may be configured to perform themedical procedure on multiple subjects substantially simultaneously.Additionally or alternatively, the robotic system 102 may include arobotic arm without a base. Additionally or alternatively, the roboticsystem 102 can be an autonomous humanoid robot (e.g., a robot withhumanoid features such as head, transport elements, manipulationelements, etc.) with a robotic arm for facilitating vascular access.

In some embodiments, the manipulation device 130 can be coupled to therobotic system 102 via a coupling element. The manipulation device 130can be configured to drive movement of one or more components (e.g., acatheter, a needle, and/or a guidewire) to facilitate vascular access.The coupling element can include any type of mechanism that can couplethe manipulation device 130 to the robotic system 102, such as, forexample, a mechanical mechanism (e.g., a fastener, a latch, a mount, ajoint), a magnetic mechanism, a friction fit, etc. The manipulationdevice 130 can be attached to a cartridge assembly (further describedwith reference to FIG. 5 ) that can include a needle, a catheter, and/ora guidewire to perform the medical procedure. In some embodiments, themanipulation device 130 can include one or more actuators that canactuate each of the needle, the catheter, and the guidewire. Theactuators can enable the manipulation device 130 to perform the medicalprocedure. The one or more actuators can be any suitable type ofactuator. For instance, the one or more actuators can include linearactuators with magnetic encoders.

In some embodiments, the robotic system 102 can include an imagingdevice (e.g., ultrasound array) to provide a user (e.g., an operator, asurgeon, etc.) with visual aid (e.g., ultrasound images showing traverseview and/or longitudinal view) as the medical procedure is performed(e.g., ultrasound images of the needle, the catheter, and/or theguidewire being inserted into a blood vessel of a subject). In someembodiments, the imaging device can be integrated and/or form part ofthe manipulation device, as further detailed with reference to FIG. 5 .

The manipulation device 130 and/or the robotic system 102 can becommunicably coupled to one or more I/O device(s) 104. An I/O device(s)104 can be any suitable input device that can be configured to receiveinputs from the user and/or any suitable output device that can beconfigured to send outputs to other devices and/or the user operatingthe robotic system 102. In some embodiments, the I/O device(s) 104 canbe an integrated computing device that includes one or more componentsto both receive inputs and send outputs. Some non-limiting examples ofintegrated computing device that can receive inputs from the user andsend outputs to the user and/or to other devices can include computers(e.g., desktops, personal computers, laptops etc.), tablets ande-readers (e.g., Apple iPad®, Samsung Galaxy® Tab, Microsoft Surface®,Amazon Kindle®, etc.), mobile devices and smart phones (e.g., AppleiPhone®, Samsung Galaxy®, Google Pixel®, etc.), etc.

In some embodiments, the I/O device(s) 104 can be a user control such asa joystick, a remote user control, keyboard, trackball, etc. that canreceive input from the user. In some embodiments, the I/O device(s) 104can be an audio device such as a microphone and/or a speaker thatreceives audio input from the user. In such embodiments, the I/Odevice(s) 104 can additionally include a display device (e.g., adisplay, a touch screen, etc.) that displays output to the user.

The manipulation device 130 and/or the robotic system 102 can beoptionally coupled to one or more sensor(s)106. The sensor(s) 106 can beconfigured to capture image data of the at least a part of the roboticsystem 102, the manipulation device 130, and/or at least a part of thesubject as the robotic system 102 performs the medical procedure on thesubject. The sensor(s) 106 can be an image sensor such as visual camera,stereo camera array, etc. The sensor(s) 106 can be operable to capturetwo-dimensional and/or three-dimensional images of the robotic system102, the manipulation device 130, and/or the subject. In someembodiments, the sensor(s) 106 can be operated remotely by the user. Forinstance, the user can be in a location away from the system 100, andthe sensor(s) can be configured to be controlled remotely using one ofthe I/O device(s) 104. Alternatively, in some embodiments, the user canbe in a location proximate to the system 100 and may not require anysensor(s) 106. In some embodiments, a user proximate to the system 100can also operate and/or adjust one or more sensor(s) 106 of the system100, e.g., one or more image sensors, to capture views of theenvironment for one or more remote users and/or for tracking/monitoringpurposes.

In some embodiments, the sensor(s) 106 can be mounted on and/or canotherwise be an integral part of the I/O device(s) 104. For instance,the sensor(s) 106 can be attached to, coupled to, and/or otherwise be apart of the I/O device(s) 104. In some embodiments, the sensor(s) 106can be mounted on the robotic system 102 itself. The sensor(s) 106 canbe operable to move (e.g., rotational and/or translational motion) suchthat the sensor(s) 106 can capture image data from various angles. Forinstance, the sensor(s) 106 can be mounted on a pan/tilt mechanism tocapture the image data. In some embodiments, the sensor(s) 106 can be aportable device such as a handheld computer tablet, a smartphone withcamera, or a digital camera that is attached to, mounted on, and/orotherwise a part of the system 100.

In order to perform the medical procedure, the I/O device(s) 104 (e.g.,user control such as joystick, keyboard, remote control, trackball,etc.) can receive an input from the user. The input can be transmittedto the robotic system 102 and/or the manipulation device 130. Forinstance, the I/O device(s) 104 can receive an input to advance theneedle, catheter, and/or guidewire into a blood vessel. The input can betransmitted from the I/O device(s) to the robotic system 102 via acommunications interface. The robotic system 102 can cause the actuatorsin the manipulation device 130 to actuate the needle, catheter, and/orguidewire (e.g., included in a cartridge assembly) based on the input.The imaging device (e.g., ultrasound array) included in the manipulationdevice can provide a visual aid of the movement (e.g., the advancement)of the needle, catheter, and/or guidewire into the blood vessel. Thevisual aid (e.g., ultrasound images showing traverse view and/orlongitudinal view) may be displayed on the I/O device(s) 104 (e.g.,display device). Subsequent input representing subsequent movement ofthe manipulation device 130 or one or more components in themanipulation device 130 (e.g., actuators actuating needle, catheter,and/or guidewire) can be provided to the I/O device(s) 104 based on thevisual aid. For example, if the position of the needle, catheter, and/orguidewire in the blood vessel is incorrect, the visual aid (e.g.,ultrasound images showing traverse view and/or longitudinal view) canguide the user to modify the input so that such component(s) advance toan appropriate location in the blood vessel.

In some embodiments, the sensor(s) 106 (e.g., camera) can provide imagedata of the robotic system 102, the manipulation device 130, and thesubject to the user. The user can remotely control the manipulationdevice 130 based on the image data. For example, the image data mayinclude images of the portion of the body of the subject that includesthe blood vessel and the orientation and/or position of the manipulationdevice 130 with respect to the portion of the body. If the orientationand/or position of the manipulation device 130 with respect to theportion of the body is incorrect, the user can remotely control themanipulation device 130 (e.g., by sending instructions to the roboticsystem 102 via the I/O device(s) 104) so as to orient and/or positionthe manipulation device 130 as desired.

In some embodiments, the user can control the sensor(s) 106 remotelyusing the I/O device(s) 104. For instance, if the captured image datadoes not include images of the manipulation device 130 or the portion ofthe body, then the sensor(s) 106 can be remotely controlled by the usersuch that the angle of the sensor(s) 106 can be changed so as to capturethe images of both the manipulation device 130 and the portion of thebody. For example, the pan/tilt mechanism on which the sensor(s) ismounted can be remotely controlled by the I/O device(s) so as to capturethe images as desired.

Subsequent inputs such as input to advance the needle, catheter, and/orguidewire can be provided remotely through the I/O device 104 based onthe image data and the visual aid (e.g., ultrasound images) obtainedfrom the imaging device (e.g., ultrasound array). In some embodiments,the robotic system 102 can be configured to automatically (e.g., via thecontrol unit in the robotic system 102) adjust the position and/ororientation of the manipulation device 130 or one or more components ofthe manipulation device 130 based on the image data and the visual aid.In this manner, the robotic system 102 along with the manipulationdevice 130 can perform the vascular access procedure (e.g., theSeldinger technique) in an automated and/or a semi-automated manner suchas with the user controlling the I/O device(s) 104 that in turn controlsand actuates the robotic system 102 and/or the manipulation device 130.

Robotic System

FIG. 2 is a block diagram that illustrates a robotic system 202 of avascular access system, according to some embodiments. The roboticsystem 202 can be functionally and/or structurally similar to otherrobotic systems described herein, such as, for example, robotic system102 in FIG. 1 . The robotic system 202 can include a base 203. The base203 can be mechanically coupled to a robotic arm 220 (e.g., similar tothe robotic arm as described with reference to FIG. 1 ) via an armsupport 210. The robotic arm 220 can be coupled to and/or integratedwith a manipulation device 230. In some embodiments, a cartridgeassembly 240 can be attached to the manipulation device 230.

Base

The base 203 can be any suitable base for positioning a manipulationdevice 230 of the vascular access system. For example, the base 203 canbe a chassis supporting the robotic arm 220 and the manipulation device230. In such scenarios, one or more electronic components such as acontrol unit, a communications interface, etc. can be attached to and/orcoupled to the base 203 (e.g., chassis). Alternatively, the base 203 canbe a structure supporting the robotic arm 220 and the manipulationdevice 230 that houses one or more electronic components such as acontrol unit, a communications interface, etc. within the base 203. Putdifferently, the outer structure of the base 203 can be a housing thatencloses one or more electronic components. The robotic arm 220 and themanipulation device 230 can be supported on the outer structure. In someembodiments, the base 203 can be a surface with a flat portionconfigured to support a patient on whom the medical procedure is to beperformed. For example, the base 203 can be a bed configured to supportthe patient. Additionally or alternatively, the base 203 can be aplatform configured to support the patient. A first portion of therobotic arm 220 can be coupled to the base 203 (e.g., bed, chassis,etc.). A second portion of the robotic arm (e.g., a second portionopposite the first portion) can be coupled to the manipulation device230. In some embodiments, the second portion of the robotic arm 220coupled to the manipulation device 230 can be movable relative to thebase 203 to position the needle, the guidewire, and the catheter forinsertion into the target vessel of the patient.

FIG. 4 is a block diagram the illustrates a base 403 (e.g., structurallyand/or functionally similar to base 203 in FIG. 2 and/or other basesdescribed herein), according to some embodiments. In some embodiments,the bottom surface of the base 403 can include transport elements 414that can provide for translation along and/or rotation of the roboticsystem (e.g., robotic system 202 in FIG. 2 ) along one or more axes.Transport elements 414 can be any suitable components configured formovement such as, for example, a wheel, a swivel caster, a track, etc.Transport elements can enable the robotic system 202 to move around.

For instance, the transport elements 414 can be swivel casters (e.g., 4swivel casters coupled to 4 corners of the base 403) that provide threedegrees of freedom to the robotic system 202. The swivel casters canallow for linear translations of the robotic system 202 along two axesand rotation of the robotic system 202 along one axis. These threedegrees of freedom can enable a user (e.g., a surgeon and/or anoperator) to achieve planar and rotational positioning of the base 403and thereby planar and rotational positioning of the robotic system 202relative to a portion of a subject's body (e.g., arm, etc., on which themedical procedure is to be performed).

In some embodiments, the base 403 can include vertical adjustmentelements 409 to move (e.g., raise or drop) the base vertically so as toposition the robotic arm 220 and the manipulation device 230 at anappropriate height with respect to a subject (e.g., a patient on whomthe medical procedure is to be performed). This can provide the roboticsystem 202 with a fourth degree of freedom. In some embodiments, thevertical adjustment elements 409 can include mechanical features to lifta top surface of the base 403 and/or drop the top surface of the base403 to a specific height. For example, the vertical adjustment elements409 can include linear rails with recirculating balls to adjust a heightof the top surface of the base 403. In some embodiments, the verticaladjustment elements 409 can include an actuator such as ball screwactuator to move the base vertically. For instance, the ball screwactuator can move the top surface of the base 403 vertically to adesired height. Once the desired height is reached, a fail-safe brakecan hold the position of the top surface while the linear rails withrecirculating balls can constraint the movement of the base 403. Inother embodiments, the top surface of the base 403 can be moved manuallyby manually adjusting the linear rails and the recirculating balls.

In some embodiments, the base 403 can include a locking mechanism 412 tolock the movement of the base 403. For instance, once a user positionsthe robotic system 202 at an appropriate position (e.g., distance and/orheight) with respect to the subject, the locking mechanism can beengaged to lock the position of the base 403 and the robotic system 202.The locking mechanism 412 can lock the transport elements 414 (e.g.,swivel casters) preventing the transport elements 414 from movingfurther. In some embodiments, the locking mechanism 412 canautomatically engage a lock. For instance, the locking mechanism 412 canautomatically lock the transport elements 414 as soon as the roboticsystem 202 is positioned at a desired location.

In some embodiments, the base 403 can include a communications interface407. The communication interface 407 can be any suitable component thatenables the base 403 and/or the robotic system 202 to communicate withI/O device(s) (e.g., I/O device(s) 104 in FIG. 1 ), sensor(s) (e.g.,sensor(s) 106 in FIG. 1 ), or other suitable devices. In someembodiments, communication interface 407 can further enable the I/Odevice(s) to communicate with the transport elements 414, verticaladjustment elements 409, and locking mechanism 412. In some embodiments,the I/O device(s) can include a user control 404 a and/or a display 404b, as further detailed below.

In some embodiments, the base 403 can include a control unit 405 tocontrol one or more components of the robotic system (e.g., roboticsystem 202 in FIG. 2 ) such as the base 403, the robotic arm (e.g.,robotic arm 220 in FIG. 2 ), the manipulation device (e.g., manipulationdevice 230 in FIG. 2 ), the cartridge assembly (e.g., cartridge assembly240 in FIG. 2 ), and/or a combination thereof. Control unit 405 can beany suitable processing device configured to run and/or executefunctions associated with controlling one or more components of therobotic system. Control unit 405 can include any suitable processor(s)that can be configured to execute modules, functions, and/or processes.In some embodiments, the processor(s) can be a general purposeprocessor, a Field Programmable Gate Array (FPGA), an ApplicationSpecific Integrated Circuit (ASIC), a Digital Signal Processor (DSP),and/or the like.

As discussed above, the base 403 can support the robotic arm (e.g.,robotic arm 220 in FIG. 2 ) and/or one or more I/O device(s) (e.g., I/Odevice(s) 104 in FIG. 1 ). For example, the base 403 can be coupled tothe robotic arm via arm support 410. One or more I/O device(s) such as,for example, user control 404 a and display 404 b can be communicablycoupled to the base 403. In some embodiments, the display 404 b canadditionally be mechanically coupled to the base 403 via the displaysupport 405 a. Display support 405 a can be any suitable support thatcan attach and/or couple display 404 b to the base 403 such that thebase 403 supports the display 404 b. In some embodiments, displaysupport 405 a can enable adjustment(s) to be made to the position and/ororientation of the display 404 a. Display 404 b can be any suitabledisplay device such as touch screen, device displaying a graphical userinterface, audio device (e.g., microphone, speaker, etc.), a combinationthereof, and/or the like.

In some embodiments, the user control 404 a can additionally be attachedto and/or integrated with the base 403. For instance, user control 404 acan be integrated with the base 403 such that the base 403 supports theuser control 404 a. User control 404 a can be any suitable device thatcan receive input from the user such as a joystick, a remote usercontrol, keyboard, trackball, etc.

Robotic Arm

Referring back to FIG. 2 , the base 203 can be coupled to the roboticarm 220 via an arm support 210. The robotic arm 220 can comprise of twoor more segments coupled together via joints. One end segment can becoupled via a joint to the arm support 210. The other end segment can beintegrated with and/or coupled to the manipulation device 230. In someembodiments, the robotic arm 220 can be actuated by one or more motors.In some embodiments, the robotic arm 220 can include one or more sensorsto measure sensory information, including information relating to therobotic arm 220. Examples of sensors include position encoders, torqueand/or force sensors, touch and/or tactile sensors, etc. The sensors canbe disposed on or integrated with either the segments, or the joints, ora combination of both. The sensory information can be transmitted to acontrol unit (e.g., control unit 405 in FIG. 4 ) included in or attachedto the base 203. Additionally or alternatively, the sensory informationcan be transmitted to one or more I/O device(s) (e.g., I/O device(s) 104in FIG. 1 ).

FIG. 3 is a block diagram the illustrates a robotic arm 320 (e.g.,structurally and/or functionally similar to robotic arm 220 in FIG. 2and/or other robotic arms described herein), according to someembodiments. In some embodiments, robotic arm 320 can be implemented asan arm that includes two segments 322 and 324. Arm support 310 (e.g.,similar to arm support 210 in FIG. 2 ) and segment 322 can be coupledtogether via joint 321. Segments 322 and 324 are coupled together viajoint 323. In some embodiments, the robotic arm can optionally includesegment 326. Segments 326 and segment 324 can be coupled together viajoints 325 a and 325 b. In some embodiments, the manipulation device 330(e.g., manipulation device 230 in FIG. 2 ) and segment 326 can becoupled together via joint 327. In other embodiments (e.g., embodimentsthat may not include segment 326), the manipulation device 330 andsegment 324 can be coupled together via joint 325 a. In yet otherembodiments, the manipulation device 330 can be integrated with segment324 or segment 326.

In some embodiments, the robotic arm 320 can have three proximal axes. Afirst proximal axis can be along arm support 310 that enables verticaltranslation of the robotic arm 320 along the arm support 310. A secondproximal axis can be along joint 321. A third proximal axis can be alongjoint 323. The three proximal axes can allow translation of the roboticarm 320 along the three-dimensional space. In some embodiments, therobotic arm can have three distal axes. A first distal axis can be alongjoint 325 a, a second distal axis can be along joint 325 b, and a thirddistal axis can be along joint 327. The three distal axes can allowrotation of the robotic arm 320 along the three-dimensional space (e.g.,pitch, yaw, and roll). In this manner, the robotic arm can have sixdegrees of freedom. In some embodiments, the second proximal axis alongjoint 321, the third proximal axis along joint 323, and the first distalaxis along 325 a can comprise a planar Selective Compliance ArticulatingRobot Arm (SCARA) linkage. While three segments and five joints aredepicted in FIG. 3 , one of ordinary skill in the art would understandthat a robotic arm can include a different number of segments and/orjoints.

In some embodiments, the robotic arm 320 can include locking mechanismsfor locking one or more components of the robotic arm 320. For example,the robotic arm can include one or more pulleys, magnets, etc. forlocking one or more joints and/or a height of the robotic arm 320relative to a base of a robotic system (e.g., base 403).

Manipulation Device and Cartridge Assembly

Referring back to FIG. 2 , an end segment of the robotic arm 220 can becoupled to the manipulation device 230. The manipulation device 230 canbe attached to a cartridge assembly 240. Further details of thecomponents of an example manipulation device and an example cartridgeassembly are described below.

FIG. 5 is a block diagram that illustrates a manipulation device 530(e.g., similar to manipulation device 230 in FIG. 2 and/or othermanipulation devices described herein) and a cartridge assembly 540(e.g., similar to cartridge assembly in FIG. 2 and/or other cartridgeassemblies described herein), according to some embodiments. In someembodiments, the manipulation device 530 can include a couplingmechanism 538, an imaging device 536, a portion of one or more deviceactuator(s) (e.g., catheter actuator 534 a, needle actuator 534 b, andguidewire actuator 534 c), collectively referred to as deviceactuator(s) 534, and optionally a control unit 532.

In some embodiments, the cartridge assembly 540 can include thedevice(s) 544 such as a catheter, a needle, and/or a guidewire.Alternatively, the manipulation device 530 can include some of thedevice(s) 544 while the cartridge assembly 540 can include otherdevice(s) 544. For instance, the manipulation device 530 can include acatheter and a guidewire while the cartridge assembly 540 can includethe needle. Similarly, the manipulation device 530 can include theguidewire and the needle while the cartridge assembly 540 can includethe catheter. In a similar manner, any suitable permutation of thecatheter, the needle, and the guidewire in the manipulation device 530and/or the cartridge assembly 540 can be possible. In some embodiments,the guidewire, the needle, and the catheter can be arranged coaxially inthe manipulation device 530. For example, the guidewire can be disposedwithin a lumen of the needle and the needle can be disposed within alumen of the catheter. In some embodiments, a length of the catheter canbe about 40 mm. In some embodiments, a length of the needle can be alittle more than 40 mm (40 mm plus bevel length) such that the needlecan extend past the catheter. In some embodiments, the guidewire can be142 mm long such that at least 50 mm of the guidewire can extend pastthe needle tip. In some embodiments, the cartridge assembly 540 can beconfigured to store the guidewire in a linear state.

In some embodiments, the cartridge assembly can also include anotherportion of the one or more device actuator(s) (e.g., catheter actuator534 a, needle actuator 534 b, and guidewire actuator 534 c),collectively referred to as device actuator(s) 534.

The imaging device 536 in the manipulation device 530 can provide theuser with a visual aid of a blood vessel as the medical procedure isbeing performed. For example, the imaging device can be any suitableimaging device that can capture a visual representation of the bloodvessel. Some non-limiting example of the imaging device 536 can includeultrasound imaging device, fluoroscopes, cameras, etc.

In some embodiments, the imaging device 536 can be an ultrasound arraylocated on the manipulation device 230. The ultrasound array can providetwo-dimensional ultrasound images along a longitudinal plane and atransverse plane. The ultrasound images with the transverse view of ablood vessel can show the radial cross section of the blood vessel andthe longitudinal view of the blood vessel can show the axial crosssection of the blood vessel. In some embodiments, the imaging device 536can be configured to obtain three-dimensional ultrasound images of theblood vessel.

The manipulation device 530 can include a portion of one or more deviceactuator(s) 534. The device actuator(s) 534 can be configured to actuatethe needle, the catheter, and/or the guidewire. For example, themanipulation device 530 can include linear actuators to actuate thedevice(s) 544. The linear actuators can include a motor such as abrushless DC motor fixed to a ball screw shaft supported by ball screwbearings. A magnetic encoder coupled to the motor can sinusoidallycommutate the motor. A linear circulating ball bearing can be coupled toa ball screw nut that is fixed on the ball screw shaft. For instance,the linear circulating ball bearing can be coupled to the ball screw nuton the ball screw shaft via a carriage block. As the ball screw shaftrotates (e.g., owing to the rotation of the motor's rotor), the ballscrew nut translates as it is constrained by the linear circulating ballbearing through the carriage block. The translation of the ball screwnut can in turn actuate a device(s) 544 along a linear axis.Accordingly, each of the needle, catheter, and guidewire can be actuatedalong a linear axis by a respective linear actuator.

Each of the needle, catheter, and guidewire can be attached to arespective guide that guides the device(s) 544 along the linear axis asthe device(s) are being actuated by the linear actuators (e.g., deviceactuator(s) 534 included in manipulation device 530). Therefore, theguides form another portion of the one or more device actuator(s) 534.In some embodiments, the guides can be included in the cartridgeassembly 540 and can be attached to the respective device(s) 544. Forexample, a needle guide 544 b included in the cartridge assembly 544 canbe attached to the needle, a catheter guide 544 a included in thecartridge assembly 544 can be attached to the catheter, and a guidewireguide 544 c included in the cartridge assembly 544 can be attached tothe guidewire. In some embodiments, the catheter guide 544 a, the needleguide 544 b, and the guidewire guide 544 c can each include a couplingelement that can couple with the coupling mechanism 538 in themanipulation device 530. For example, the catheter guide 544 a, theneedle guide 544 b, and the guidewire guide 544 c can each include apuck. In some embodiments, the puck can comprise a magnetic elementand/or a magnetic portion (e.g., embedded steel disk).

The manipulation device 530 can include coupling mechanism 538 thatcouples the cartridge assembly 540 (e.g., the coupling element in thecartridge assembly 540) to the manipulation device 530, such as, forexample, a mechanical mechanism (e.g., a fastener, a latch, a mount), amagnetic mechanism, a friction fit, etc. In some embodiments, thecoupling mechanism can be a magnetic mechanism. For instance, considerthe example embodiment described above with the portion of deviceactuator(s) 534 included in the manipulation device 530 being linearactuators. The ball screw shaft in the linear actuator can be coupled toa carriage block. A magnet (e.g., ferromagnet, permanent electromagnet,etc.) can be fixed to the carriage block. The coupling element (e.g.,puck) included in the guide(s) 544 a, 544 b, 544 c can be aligned withthe carriage block. The magnet in the carriage block engages thecoupling element (e.g., puck) in the cartridge assembly 540 with thecarriage block in the manipulation device 530. In some embodiments, themagnetic portion in the coupling element (e.g., puck) can act as anarmature to close the magnetic circuit in the magnet, thereby engagingthe coupling element in the cartridge assembly 540 with the manipulationdevice 530.

In some embodiments, the coupling mechanism 538 can be a mechanicalmechanism. For example, the coupling mechanism 538 can include slots(e.g., recessed portions in the manipulation device 530) such that thecatheter guide 544 a, the needle guide 544 b, and the guidewire guide544 c included in the cartridge assembly 540 can fit within the slots.In some embodiments, the coupling mechanism 538 can be a combination ofthe magnetic mechanism and the mechanical mechanism.

In some embodiments, the manipulation device 530 can optionally includea control unit 532 to control the actuation of the device actuator(s)534. Control unit 532 can be any suitable processing device configuredto run and/or execute functions associated with controlling the deviceactuator(s) 534. Control unit 532 can include any suitable processor(s)that can be configured to execute modules, functions, and/or processes.In some embodiments, the processor(s) can be a general purposeprocessor, a Field Programmable Gate Array (FPGA), an ApplicationSpecific Integrated Circuit (ASIC), a Digital Signal Processor (DSP),and/or the like.

Methods

FIG. 6 is a flow diagram illustrating a method 600 of performing amedical procedure (e.g., using system 100 in FIG. 1 ), in accordancewith some embodiments. A robotic system, such as, for example, roboticsystem 102 in FIG. 1 and/or any of the other robotic systems describedherein, can perform the medical procedure (e.g., vascular accessprocedure) in an automated and/or semi-automated manner. At 602, a base(e.g., base 203 in FIG. 2 or base 403 in FIG. 4 ) can be moved to alocation next to a subject (e.g., a patient). As discussed above, thebase can include transport elements (e.g., swivel casters) that canallow for translational and rotational movement of the robotic system.The base can be moved to a suitable position from the subject such thatthe medical procedure can be performed on the subject. For example, thebase can be moved to a position that allows a robotic arm (e.g., roboticarm 220 in FIG. 2 or robotic arm 320 in FIG. 3 ) access a portion of thesubject's body (e.g., patient's arm on which the medical procedure is tobe performed). In some embodiments, the base can be moved to positionthe robotic arm such that at least a portion of the manipulation deviceand/or the cartridge assembly touches the skin of the subject. In someembodiments, an I/O device (e.g., I/O device(s) 104 in FIG. 1 or usercontrol 404 a in FIG. 4 ) communicably coupled to the base and/orcommunicably coupled to the transport elements included in the base cantransmit instructions to move the base. For example, the I/O device canbe configured to transmit instructions to an actuator controlling themovements of the swivel caster. In other embodiments, the base can bemoved manually by a user.

In some embodiments, the base can be moved up or dropped down in avertical manner so as to position the base and/or the robotic armsuitably in order to perform the medical procedure. As discussed above,the base can include vertical adjustment element(s) (e.g., verticaladjustment element(s) 409 in FIG. 4 ) to adjust a height of a topsurface of the base. In some embodiments, an I/O device (e.g., I/Odevice(s) 104 in FIG. 1 or user control 404 a in FIG. 4 ) communicablycoupled to the base and/or communicably coupled to the verticaladjustment element(s) can transmit instructions to adjust the height ofthe top surface of the base. For example, the I/O device can beconfigured to transmit instructions to an actuator controlling thevertical adjustment element(s). In other embodiments, the verticaladjustment element(s) can be manipulated manually by a user so as toadjust the height of the top surface of the base. Once the base is movedto a suitable location from the subject (e.g., suitable distance and/orsuitable height), the base can be locked (e.g., using lockingmechanism(s) 412 in FIG. 4 ) to lock the location of the base (at 603 inFIG. 6 ).

At 604, a cartridge assembly (e.g., cartridge assembly 240 in FIG. 2 orcartridge assembly 540 in FIG. 5 ) can be attached to a manipulationdevice (e.g., manipulation device 130 in FIG. 1 , manipulation device230 in FIG. 2 , manipulation device 330 in FIG. 3 , or manipulationdevice 530 in FIG. 5 ). The manipulation device can be coupled to orotherwise be a part of the robotic arm. In some embodiments, themanipulation device can include coupling mechanism(s) (e.g., couplingmechanism(s) 538 in FIG. 5 ) to couple the cartridge assembly to themanipulation device. For example, the manipulation device can include apermanent electromagnet that magnetically couples the manipulationdevice to the cartridge assembly. A coupling element (e.g., puck) in thecartridge assembly can comprise a magnetic portion (e.g., an embeddedstainless steel disk) that can close a magnetic circuit with the magnet(e.g., permanent electromagnet). In this manner, the cartridge assemblycan be attached to the manipulation device. Additionally oralternatively, the manipulation device can include recessed portions(e.g., slots) to receive portions of the cartridge assembly. Forinstance, the device(s) (e.g., device(s) 544 in FIG. 5 ) along withguide(s) (e.g., device actuator(s) 534 in FIG. 5 ) can be configured tofit within the recessed portions of the manipulation device. In thismanner, the cartridge assembly can be mechanically coupled to themanipulation device.

In some embodiments, the robotic arm can include locking mechanisms tolock and unlock the robotic arm. Locking the robotic arm can preventfurther movement of the robotic arm. Unlocking the robotic arm canenable the robotic arm to move as desired. In some embodiments, at 605,the method 600 can include unlocking the robotic arm if the robotic armis in locked position.

At 606, the method 600 can include moving the robotic arm to positionthe cartridge assembly at target site. The target site can be a portionof a subject's body on which the medical procedure is to be performed.For example, the target site can be an arm of a patient's body on whichthe Seldinger technique is to be performed. Moving the robotic arm caninclude positioning the cartridge assembly at a desired locationrelative to the target site. For instance, the cartridge assembly can bepositioned at an angle with respect to a blood vessel in the target site(e.g., patient's arm). In some embodiments, the angle can be betweenabout 0 degrees and about 90 degrees, between about 10 degrees and about80 degrees, between about 20 degrees and about 70 degrees, between about30 degrees and about 60 degrees, between about 40 degrees and about 50degrees with respect to the blood vessel. In some embodiments, the anglecan be between about 20 degrees and about 60 degrees. Additionally oralternatively, the cartridge assembly can be positioned at a specificdistance from the blood vessel. In some embodiments, the robotic arm canbe moved to position the cartridge assembly such that at least a portionof the cartridge assembly touches the skin of the subject. In someembodiments, moving the robotic arm can include transmittinginstructions from an I/O device to the robotic system and/or the roboticarm. For instance, a user can transmit instructions to move the roboticarm via an input device such as joystick, mouse, keyboard, buttons, etc.Once the robotic arm is moved to position the cartridge assembly at thetarget site, at 607, the robotic arm can be locked to prevent furthermovement.

At 610, the method 600 can include controlling the manipulation deviceto perform a vascular access procedure, e.g., the Seldinger technique.In some embodiments, an I/O device (e.g., I/O device(s) 104 in FIG. 1 oruser control 404 a in FIG. 4 ) communicably coupled to the roboticsystem can transmit instructions to the robotic system (e.g., a controlunit included in the robotic system) so as to control the movement ofthe robotic arm. For instance, a control unit (e.g., control unit 405 inFIG. 4 ) included in the robotic system (e.g., control unit in the base,control unit in the robotic arm, etc.) can process instructions (e.g.,instructions from the I/O device) to control the manipulation device.For example, the needle, the catheter, and/or the guidewire can beactuated based on the instructions. Feedback from sensor(s) (e.g.,sensor(s) 106 in FIG. 1 ) and/or imaging device (e.g., imaging device536 in FIG. 5 ) can be used for further subsequent control of themanipulation device. For instance, subsequent control of the actuationof the needle, the catheter, and/or the guidewire can be based onfeedback from sensor(s) and/or the imaging device.

FIG. 7 is a flow diagram illustrating a method 700 of gaining vascularaccess, for example, by performing the Seldinger technique (e.g., usingsystem 100 in FIG. 1 or any of the other systems and/or componentsdescribed herein), in accordance with some embodiments. At 712, themethod 700 can include receiving user input to access a blood vessel.For instance, the user input can include instructions to performarterial insertion. In some embodiments, a user can transmit an input toperform the arterial insertion to a robotic system (e.g., robotic system102 in FIG. 1 , robotic system 202 in FIG. 2 , etc.) via an I/O device(e.g., I/O device(s) 104 in FIG. 1 or user control 404 a in FIG. 4 )that is communicably coupled to the robotic system. The robotic systemcan be controlled based on the input so as to position and/or orient therobotic system to perform the arterial insertion. For example, the base(e.g., base 203 in FIG. 2 ), the manipulation device (e.g., manipulationdevice 230 in FIG. 2 ), and/or the cartridge assembly (e.g., cartridgeassembly 240 in FIG. 2 ) can be positioned and/or oriented based on theuser input such that the cartridge assembly is at a specific distanceand/or orientation from the desired artery.

At 714, the method 700 can include activating an actuator (e.g., needleactuator 534 b in FIG. 5 ) to move a needle to puncture the artery. Insome embodiments, the needle can be included in the cartridge assembly.The needle can be coupled to a needle guide (e.g., a portion of theneedle actuator 534 b included in the cartridge assembly) that caninclude a coupling element such as a puck comprising a magnetic portion(e.g., an embedded steel disk). A recessed portion in the manipulationdevice can be configured to fit the needle guide along with the needle.The cartridge assembly can be attached to the manipulation device via amagnet (e.g., permanent electromagnet) included in a carriage block(e.g., coupling mechanism 538 in FIG. 5 ) that completes a magneticcircuit with the magnetic portion.

In response to the input from the user (e.g., via an I/O device) toperform arterial insertion, a linear actuator (e.g., portion of theneedle actuator 534 b included in the manipulation device) to actuatethe needle can be activated. The linear actuator can move along a linearaxis. This in turn can cause the needle guide along with the needle tomove along the linear axis. Accordingly, the needle can be moved andpositioned so as to puncture the desired artery. In some embodiments,performing the arterial insertion can include aligning a tip of theneedle to a catheter tip. As the tip of the needle is advanced into thedesired artery, the tip of the needle may remain in the samelongitudinal plane. However, the transverse plane of the tip of theneedle may change as the needle advances.

In some embodiments, the user can visualize the movement of the needleusing visual aid (e.g., ultrasound images) captured by an imaging device(e.g., imaging device 536 in FIG. 5 ). For example, the absoluteposition of the tip of the needle can be determined in order todetermine the transverse plane that is to be captured through the visualaid. The visual aid can provide the user with information on themovement of the needle. In some embodiments, the user can visualize themovement of the robotic arm, manipulation device, and/or the cartridgeassembly as the needle is being actuated using sensor data obtained fromsensor(s) (e.g., sensor(s) 106 in FIG. 1 ). The user can modify theinput to perform arterial insertion based on the visual aid and/or thesensor data.

At 716, the method 700 can include receiving user input (e.g., via anI/O device) to advance the guidewire into the artery. Once the arteryhas been punctured and the needle positioned in the artery, the user cantransmit instructions (e.g., similar to step 712) to advance theguidewire into the artery.

At 718, in response to the instructions at 716, the method 700 caninclude activating an actuator (e.g., guidewire actuator 534 c in FIG. 5) to advance the guidewire into the artery. Similar to the needle, theguidewire can be included in the cartridge assembly. The guidewirecoupled to a guidewire guide (e.g., a portion of the guidewire actuator534 c included in the cartridge assembly) can be attached to themanipulation device via a permanent electromagnet in a carriage block.Additionally and/or alternatively, a recessed portion in themanipulation device can be configured to fit the guidewire guide alongwith the guidewire.

In response to the user input (e.g., via an I/O device) to advance theguidewire, a linear actuator (e.g., portion of the guidewire actuator534 c included in the manipulation device) to actuate the guidewire canbe activated. The linear actuator can move along a linear axis. This inturn can cause the guidewire guide along with the guidewire to movealong the linear axis. Accordingly, the guidewire can be advanced to thedesired location in the artery. The needle and the catheter can be heldstationary as the guidewire is advanced into the artery. In someembodiments, the user can visualize the movement of the guidewire usingvisual aid captured by the imaging device. The transverse plane that isto be captured via the visual aid can be updated based on the absoluteposition of a tip of the guidewire. In some embodiments, the user canvisualize the movement of the robotic arm, manipulation device, and/orthe cartridge assembly as the guidewire is being advanced using sensordata obtained from the sensor(s). The user can modify the input toadvance the guidewire based on the visual aid and/or the sensor data.

At 720, the method 700 can include receiving user input (e.g., via anI/O device) to advance the catheter into the artery. In someembodiments, the user can transmit instructions (e.g., similar to step712) to advance the catheter into the artery.

At 722, in response to the instructions at 720, the method 700 caninclude activating an actuator (e.g., catheter actuator 534 a in FIG. 5) to advance the catheter into the artery. Similar to the needle, thecatheter can be included in the cartridge assembly. The catheter coupledto a catheter guide (e.g., a portion of the catheter actuator 534 aincluded in the cartridge assembly) can be attached to the manipulationdevice via a permanent electromagnet in a carriage block. Additionallyand/or alternatively, a recessed portion in the manipulation device canbe configured to fit the catheter guide along with the catheter.

In response to the user input (e.g., via an I/O device) to advance thecatheter, a linear actuator (e.g., portion of the catheter actuator 534a included in the manipulation device) to actuate the catheter can beactivated. The linear actuator can move along a linear axis. This inturn can cause the catheter guide along with the catheter to move alongthe linear axis. Accordingly, the catheter can be advanced to thedesired location in the artery. In some embodiments, the user canvisualize the movement of the catheter using visual aid captured by theimaging device. In some embodiments, the user can visualize the movementof the robotic arm, manipulation device, and/or the cartridge assemblyas the catheter is being advanced using sensor data obtained from thesensor(s). The user can modify the input to advance the catheter basedon the visual aid and/or the sensor data.

At 724, the method 700 can include receiving user input (e.g., via anI/O device) to retract the needle and the guidewire. At 726, in responseto the instructions at 724, the method 700 can include activating theneedle actuator and the guidewire actuator to retract the needle and theguidewire. For example, the linear actuators to actuate the needle andthe guidewire respectively can be activated such that the linearactuators retract back into the manipulation device along the linearaxis. Therefore, the needle guide along with the needle and theguidewire guide along with the guidewire retract into the cartridgeassembly along the linear axis (since the needle guide along with theneedle and the guidewire guide along with the guidewire are attached totheir respective linear actuators). In some embodiments, the user canvisualize the movement of the retraction of the needle and the guidewireusing visual aid captured by the imaging device. In some embodiments,the user can visualize the movement of the robotic arm, manipulationdevice, and/or the cartridge assembly as the needle and/or the guidewireis being retracted using sensor data obtained from the sensor(s). Theuser can modify the input to retract the needle and/or the guidewirebased on the visual aid and/or the sensor data.

At 728, the method 700 can include decoupling the catheter from thecartridge assembly. In some embodiments, decoupling the catheter caninclude decoupling the catheter guide along with the catheter from thecartridge assembly. For example, as discussed above, the catheter guidecan be attached to a linear actuator via a permanent electromagnet inthe manipulation device. The catheter guide can include a puckcomprising a magnetic portion (e.g., an embedded steel disk). Themagnetic portion can act as an armature to close the magnetic circuit inthe magnet (e.g., permanent electromagnet). Accordingly, the puck can beattached to the magnet in power-on and power-off scenarios. In order torelease the puck, current can be applied to the magnet. In this manner,by energizing the magnet, the puck and thereby the catheter guide can bereleased from the cartridge assembly. Alternatively, the catheter can bedetached from the catheter guide without releasing the catheter guidefrom the cartridge assembly. For example, the user can manually decouplethe catheter from the catheter guide without decoupling the catheterguide from the cartridge assembly.

Although in FIG. 7 , the sequence of steps to gain access to a bloodvessel is described as activating an actuator to advance the needlefollowed by activating an actuator to advance the guidewire andsubsequently activating an actuator to advance the catheter, it shouldbe readily understood that the sequence of steps to gain access to ablood vessel using the system and methods described herein can beperformed in any suitable permutations and combinations. For example, insome embodiments, one or more actuators can be activated to advance theneedle, the catheter, and the guidewire simultaneously. Once the needlepunctures the desired blood vessel (e.g., artery), the guidewire can beadvanced distal to the needle to a desired position in the blood vessel.The catheter can then be advanced over the guidewire to the desiredposition in the blood vessel. In some embodiments, after advancing theguidewire but before advancing the catheter to the desired position inthe blood vessel, the needle can be retracted slightly (e.g., movedproximal by a small distance) so that advancing the catheter may beatraumatic to the subject. Alternatively, one or more actuators can beactivated to align the needle tip and the distal end of the catheter.The needle and the catheter can be advanced simultaneously to a desiredblood vessel. Once the needle punctures the desired blood vessel, theguidewire can be advanced through the puncture to a desired position inthe blood vessel. The catheter can then be further advanced to thedesired position in the blood vessel. As discussed above, these are afew examples to illustrate various permutations and combinations foraccessing a blood vessel using the systems and methods described herein.

In some embodiments, if the size of the blood vessel is large (e.g.,central vein), a second catheter can be advanced over the first catheterin order to perform the medical procedure. Put differently, one or moreactuators can advance the needle, the guidewire, and the catheter to adesired position in the desired blood vessel. Then, the needle and theguidewire can be retracted from the blood vessel. Another guidewire canbe advanced (e.g., manually and/or autonomously) through the catheteralready positioned in the desired location. A second catheter that isbigger in size than the already positioned catheter can be advancedthrough the guidewire. In this manner, the second larger catheter can bepositioned through the first catheter in order to perform the medicalprocedure. In some embodiments, one or more dilators can be used beforepositioning either the first catheter (e.g., catheter advanced usingactuator(s) in the manipulation device and/or cartridge assembly) and/orthe second catheter (e.g., catheter that is larger than the firstcatheter and is advanced through the first catheter) during the medicalprocedure.

In some embodiments, method 700 as described herein can be performedautonomously and/or semi-autonomously. Accordingly, one or more steps ofreceiving user input (e.g., 712, 716, 720, 724) can be optional, andsystems and devices described herein can be configured to automaticallyproceed from actuating one component to the next based on confirmationthat a first step has been completed. Such confirmation can bedetermined via sensor data (e.g., via sensor(s) 106) and/or imaging data(e.g., via imaging device 536). In some embodiments, one or more stepsmay be performed without user input while other steps may be performedwith user input.

FIG. 8 is a flow diagram illustrating a method 800 of using visual aidand/or sensor data to perform a medical procedure (e.g., using system100 in FIG. 1 ), in accordance with some embodiments. At 812, the method800 can include receiving user input to perform a step of the medicalprocedure (e.g., vascular access procedure). For example, the user inputcan include instructions to perform arterial insertion (e.g., step 712in FIG. 7 ), advance a guidewire into a blood vessel (e.g., step 716 inFIG. 7 ), advance a catheter into a blood vessel (e.g., step 720 in FIG.7 ), and/or retract a needle and the guidewire from the blood vessel(e.g., step 724 in FIG. 7 ).

At 814, the method 800 can include activating actuators to move medicalinstruments based on the user input. For example, activating actuatorscan include activating actuators within a robotic system (e.g., roboticsystem 202 in FIG. 2 and/or other robotic systems described herein) tomove transport elements (e.g., transport element 414 in FIG. 4 ) and/orvertical adjustment elements (e.g., vertical adjustment element(s) 409in FIG. 4 ) included in the robotic system based on the user input. Thisin turn can cause a robotic arm (e.g., robotic arm 220 in FIG. 2 and/orother robotic arms described herein), a manipulation device (e.g.,manipulation device 230 in FIG. 2 and/or other manipulation devicesdescribed herein), and/or a cartridge assembly (e.g., cartridge assembly240 in FIG. 2 and/or other cartridge assemblies described herein) to bepositioned at a desired location from a target site (e.g., subject'sbody part such as arm). In some embodiments, activating actuators caninclude activating device actuators (e.g., device actuator(s) 534 inFIG. 5 ) to advance (e.g., steps 714, 718, and 722 in FIG. 7 ) and/orretract (e.g., step 726 in FIG. 7 ) the needle, the catheter, and/or theguidewire into/from a blood vessel based on the user input.

At 816, the method 800 can include capturing visual aid and/or sensordata as the step of the vascular access procedure is being performed.For example, the manipulation device can include an imaging device(e.g., imaging device 536 in FIG. 5 ) to capture visual aid (e.g.,ultrasound images) of the needle, the catheter, and/or the guidewire(collectively device(s) 544 in FIG. 5 ) as the device(s) are beingadvanced into and/or retracted from the blood vessel. In someembodiments, the robotic system can be communicably coupled to a sensor(e.g., sensor(s) 106 in FIG. 1 ) such as a camera to capture images ofthe robotic system, the manipulation device, and/or the cartridgeassembly as the step of the vascular access procedure is beingperformed.

At 818, the visual aid and/or the sensor data can be displayed on an I/Odevice (e.g., I/O device(s) 104 in FIG. 1 or user control 404 a in FIG.4 ). For example, ultrasound images and/or images from cameras can bedisplayed on a display. At 822, if a user input to stop performing thestep of the medical procedure is received (e.g., at step 820), themethod 800 can include activating the actuators to remove the medicalinstruments from the target site. For example, the needle, the catheter,and/or the guidewire can be retracted from the blood vessel byactivating the device actuators. Additionally or alternatively, therobotic system, the manipulation device and/or the cartridge assemblycan be moved away from the subject by activating the actuators coupledto the transport elements and/or the vertical adjustment elements. Insome embodiments, the cartridge assembly can be detached from themanipulation device.

At 824, the method 800 can include indicating to the user that the stepof the vascular access procedure is complete. For example, the displaycan output visual, audio, and/or haptic outputs to represent that thestep of the medical procedure is complete. In some embodiments, thedisplay can also prompt the user to initiate the next step therebyrepeating the steps of method 800. If the user input to stop performingthe step of the medical procedure is not received at step 820, themethod 800 can include at 824 indicating to the user that the step ofthe vascular access procedure is complete and prompting the user toinitiate the next step of the vascular access procedure.

Examples

FIG. 9A illustrates a vascular access system 900A (e.g., structurallyand/or functionally similar to system 100 in FIG. 1 ), in accordancewith some embodiments. The vascular system can include a robotic systemthat can include a base 903 (e.g., structurally and/or functionallysimilar to base 203 in FIG. 2 ), robotic arm 920 (e.g., structurallyand/or functionally similar to robotic arm 220 in FIG. 2 ), andmanipulation device 930 (e.g., structurally and/or functionally similarto manipulation device 230 in FIG. 2 ).

The base 903 can be a movable base. For example, the base 903 caninclude transport elements 914 (e.g., structurally and/or functionallysimilar to transport elements 414 in FIG. 4 ). In some embodiments, thetransport elements 914 can be swivel casters with lockable wheels. Theswivel casters can provide the base 903 with three degrees of freedom.For example, the swivel casters can provide translations along the Ucoordinate axis and the V coordinate axis shown in FIG. 9A.Additionally, the swivel casters can provide rotation along the Wcoordinate axis shown in FIG. 9B. The planar and rotational movement canenable the base 903 to be positioned relative to a subject's (e.g.,patient on whom the medical procedure is to be performed) arm. In someembodiments, a locking mechanism (e.g., locking mechanism 412 in FIG. 4) for the transport elements 914 can lock a position of the base 903during the medical procedure. For example, in some embodiments, locksmay be engaged automatically during a step of the medical procedure suchas upon the base being positioned at an appropriate position relative tothe arm of a patient on whom the medical procedure is to be performed.

In some embodiments, the base 903 can include vertical adjustmentelement(s) 909 (e.g., structurally and/or functionally similar tovertical adjustment element(s) 409 in FIG. 4 ) which can provide afourth degree of freedom to the base 903. The vertical adjustmentelement(s) can raise and/or drop the base vertically, thereby providingthe base 903 with a fourth degree of freedom. In some embodiments, thevertical adjustment element(s) 909 can lift a top surface 946 of thebase 903 to position the robotic arm 920 at an appropriate height withrespect to the patient on whom the medical procedure is to be performed.In some embodiments, the vertical adjustment element(s) 909 can bemotorized. For example, the vertical adjustment element(s) 909 caninclude a ball screw actuator. A fail-safe brake can hold the positionof the top surface 946 of the base 903. Linear rails with recirculatingballs can constraint the movement of the base 903.

In some embodiments, the top surface 946 of the base 903 can be attachedto, integrated with, and/or otherwise coupled to one or more I/Odevice(s). For example, a display 904 b (e.g., structurally and/orfunctionally similar to display 404 b in FIG. 4 ) can be mechanicallycoupled to the top surface 946 of the base via a display support. Thedisplay 904 b can provide visual aid and/or visual feedback includinglongitudinal and traverse ultrasound views of a blood vessel of thesubject. In some embodiments, the display 904 b can provide state andstatus information on the task being performed during the medicalprocedure. Some examples of state information can include the state ofthe needle actuator, guidewire actuator, and/or catheter actuator duringeach step of the medical procedure as seen in Table 1.

TABLE 1 Medical Guidewire Needle Catheter procedure Actuator ActuatorActuator Step Description (motor) (motor) (motor) 1 Insertion into bloodvessel Dynamic Dynamic Dynamic 2 Advance guidewire into the DynamicStatic Static blood vessel 3 Advance catheter into the Static StaticDynamic blood vessel 4 Retract needle and Dynamic Dynamic Staticguidewire

In some embodiments, a user control 904 a (e.g., structurally and/orfunctionally similar to user control 404 a in FIG. 4 ) can be attachedto and/or integrated with the top surface 946 of the base 903. Forexample, a joystick 904 a as shown in FIG. 9A can be used to control therobotic system. For instance, the joystick 904 a may control the threedegrees of freedom (e.g., translation and rotation) and/or four degreesof freedom (e.g., translation, rotation, and/or vertical drop or raise)of the base 903. The joystick 904 a can be any suitable type of joysticksuch as digital joysticks, paddle joysticks, analog joysticks, Pc analogjoysticks, and/or the like.

Additionally or alternatively, a handheld pendant (e.g., handheldpendant 1104 a in FIG. 11A further described below) can be used tocontrol the robotic system. In addition to controlling the three and/orfour degrees of freedom of the base 903, the handheld pendant canadditionally control the needle actuator, guidewire actuator, and/orcatheter actuator prior to, during, and/or after each step of theSeldinger technique based on the states shown in Table 1. For example,the handheld pendant can change the state of the needle actuator and thecatheter actuator from dynamic to static after arterial insertion butbefore advancing the guidewire into the artery.

In some embodiments, the top surface 946 of the base 903 can be attachedto, integrated with, and/or otherwise coupled to the robotic arm 920. Insome embodiments, the top surface 946 of the base 903 can include an armrestraint 948 to constrict the arm of a subject during the medicalprocedure. The arm restraint 948 can be an elastic band that canrestraint an arm of any size.

FIG. 9B illustrates a vascular access system 900B (e.g., structurallyand/or functionally similar to system 100 in FIG. 1 ), in accordancewith some embodiments. In addition to the components in system 900A, thesystem 900B additionally includes a sensor 906 (e.g., structurallyand/or functionally similar to sensor 106 in FIG. 1 ). The sensor 906can be coupled to a top surface of the base 903. The sensor 906 can bean image sensor and/or an image capturing device that can capture imagedata of at least a part of the robotic system, the manipulation data,and/or part of the subject as the robotic system performs the medicalprocedure on the subject. For example, the sensor 906 can be athree-dimensional vision system such as a stereo camera and/or a cameraarray. The sensor 906 can be mounted on a pan/tilt mechanism 966.

FIG. 10 illustrates an example stereo camera array 1006 to capture imagedata, according to some embodiments. The stereo camera array 1006 caninclude one or more individual image sensors such as for example, righteye camera 1068 a and left eye camera 1068 b. The right eye camera 1068a and the left eye camera 1068 b can capture images of the environment(e.g., at least a part of the robotic system, the manipulation data,and/or part of the subject as the robotic system performs the medicalprocedure on the subject). In some embodiments, the stereo camera array1006 can be mounted on a pan/tilt mechanism including a tilt axis ofrotation 1066 a and a pan axis of rotation 1066 b. The stereo camera1006 a can be tilted as desired along the tilt axis of rotation 1066 a.The stereo camera 1006 can be panned and/or swiveled along the pan axisof rotation 1066 b. In some embodiments, the pan/tilt mechanism andthereby the stereo camera array 1006 can be controlled by a userproximate to the stereo camera array 1006. Alternatively, the pan/tiltmechanism and thereby the stereo camera array 1006 can be controlled bya user remotely.

Referring back to FIG. 9A, the sensor 906 can be configured to becontrolled remotely using one or more I/O devices. For instance, thesensor 906 can be controlled by an I/O device that is communicablycoupled to the robotic system and/or base 903. A user controlling thesensor 906 can be at a location remote to the system 900B. For example,the sensor 906 can be controlled via an integrated computing device suchas computers (e.g., desktops, personal computers, laptops etc.), tabletsand e-readers (e.g., Apple iPad®, Samsung Galaxy® Tab, MicrosoftSurface®, Amazon Kindle®, etc.), mobile devices and smart phones (e.g.,Apple iPhone®, Samsung Galaxy®, Google Pixel®, etc.), etc. that iscommunicably coupled to the robotic system and/or base 903. In someembodiments, the user control 904 a can enable a user in proximityand/or within the vicinity of the system 900B to control the sensor 906.

The sensor 906 can capture a view of the environment for the remoteuser. Controlling the pan/tilt mechanism can allow the sensor 906 tocapture image data from various angles. A user can change the view ofthe environment as desired by controlling the pan/tilt mechanism. Theimage data can be used as feedback by the user to control the roboticsystem in order to perform the medical procedure. In some embodiments,instead of a user controlling the pan/tilt mechanism via an I/O devicesuch as user control 904 a, the entire system (e.g., system 900A in FIG.9A and/or system 900B in FIG. 9B) can be autonomous. For instance, acontrol unit within the system can control the user control 904 a and/orpan/tilt mechanism 966 by taking into account the feedback from imagedata and/or visual aid (e.g., ultrasound data) as the robotic systemperforms the medical procedure. Put differently, the system 900A and/or900B can perform the medical procedure in an autonomous manner.

In some embodiments, the system may include an additional image sensorsuch as stereo camera (not shown in FIGS. 9A and 9B) to enable precisemotion of the robotic arm 920 and/or manipulation device 930. Theadditional image sensor can allow precise targeting and/or access of thevascular portion. For instance, the feedback from the additional imagesensor can control the manipulation device 930 and/or the robotic arm920 in a more precise manner. In some embodiments, proximity sensor(s)may be attached to, coupled to, and/or otherwise mounted on the base 903to enable previse motion and targeting.

In some embodiments, when the manipulation device 930 contact the skinof the subject, the feedback can be switched from sensor 906 feedback tovisual aid from an imaging device such as ultrasound array. For example,a user remote to the system can switch the feedback to ultrasound usingan I/O device. As discussed above, in some embodiments, the robotic arm920 can be motorized. The motorized arm can be controlled (e.g., via anI/O device) to achieve a desired view of a target vascular portion ofthe subject in the ultrasound array.

In some embodiments, the robotic arm 920 can include sensors to measureforce and/or torque in order to perform the medical procedure in a safemanner. For instance, a needle penetration force that is greater than athreshold value can cause damage to the skin, blood vessel, and/orneighboring tissues. Accordingly, measuring the force and/or torqueduring the medical procedure can ensure the needle penetration force isbelow the threshold value. For example, for a 25 G needle the maximumpenetration force that can be applied by the needle to puncture aforearm vein is 2.5 N. Similarly, maximum penetration force can bedetermined for 18 G needle, 22 G needle, etc. If the penetration forcemeasured by the sensors exceed the identified maximum penetration value,in some embodiments, the system 900A and/or 900B can be automaticallyshutdown. For example, in response to the penetration force exceedingthe penetration value a control unit (e.g., structurally and/orfunctionally similar to control unit 405 in FIG. 4 ) can automaticallyshutdown the system. In some embodiment, the measured force can also bean indicator of whether or not the needle may have penetrated into atissue of the subject. For example, when the needle penetrates thetissue, the penetration force can drop. In such scenarios, a user can benotified via a display (e.g., structurally and/or functionally similarto display 404 b in FIG. 4 ) that the needle has penetrated the tissue.In some embodiments, the robotic arm 920 can include collision sensingskin sensors to identify whether the manipulation device 930 is incontact with the skin of the subject prior to performing the medicalprocedure.

FIG. 11A illustrates a robotic system 1102A (e.g., structurally and/orfunctionally similar to robotic system 202 in FIG. 2 ), according tosome embodiments. The robotic system 1102A includes a base 1103. A usercontrol 1104 a can be attached to, coupled to, and/or integrated withthe base 1103. In some embodiments, the user control 1104 a can be ahandheld pendant. The handheld pendant 1104 a can be coupled to the base1103 via a spiral cord. As discussed above, the handheld pendant 1104 acan control the linear motion, rotational motion, and/or verticalmovement of the base 1103. Additionally, the handheld pendant 1104 a canchange the state of the system itself or otherwise one or morecomponents of the system (e.g., needle actuator, catheter actuator,guidewire actuator, etc.) from one step of the medical procedure (e.g.,the Seldinger technique) to the next step of the medical procedure. Somenon-limiting examples of the state of some components for each step ofthe Seldinger technique is shown in table 1. For example, the handheldpendant 1104 a can be used to change the state of the guidewire actuatorfrom dynamic to static and the state of the catheter actuator fromstatic to dynamic after advancing the guidewire into the artery of asubject but before advancing the catheter into the artery of thesubject.

In some embodiments, a display 1104 b can be attached to, coupled to,and/or integrated with the base 1103. The display 1104 b can displayvisual aid (e.g., transverse view and longitudinal view of ultrasoundimages), image data (e.g., images captured from a sensor such ascamera), status, and state of the task being performed. In someembodiments, a robotic arm 1120 can be attached to, coupled to, and/orintegrated with the base 1103. In some embodiments, the robotic arm 1120can be motorized. In some embodiments, an end segment of the robotic arm1120 can be coupled to a manipulation device 1130. The manipulationdevice can be attached to a cartridge assembly.

In some embodiments, the base 1103 can include transport elements 1114such as swivel wheels. The transport elements 1114 can provide threedegrees of freedom to the base 1103. FIG. 11B illustrates rotationalmotion and vertical movement for a base 1103, according to someembodiments. The transport elements 1114 can allow the base 1103 torotate along 1186 a. Additionally, the transport elements 1114 can allowthe base 1103 to move linearly along two perpendicular axes, therebyproviding three degrees of freedom. Additionally, the base 1103 caninclude vertical elements to raise and/or drop the base 1103 along 1186b. This can provide a fourth degree of freedom to the base.

FIGS. 12A-12C illustrates a robotic arm (e.g., structurally and/orfunctionally similar to robotic arm 220 in FIG. 2 and/or robotic arm 320in FIG. 3 ), according to some embodiments. As seen in FIG. 12A, therobotic arm can include segment 1222 and segment 1224 coupled togethervia one or more joints 1223. Segment 1224 and segment 1226 can becoupled together via one or more joints 1225. In some embodiments,manipulation device 1230 (e.g., structurally and/or functionally similarto manipulation device 230 in FIG. 2 ) and segment 1226 can be coupledtogether via one or more joints 1227. Alternatively, the manipulationdevice 1230 can be integrated with segment 1226.

As seen in FIG. 12B, the robotic arm can have three proximal axes (axesnot shown in FIG. 12B, 1292 a, and 1292 b). The first proximal axis (notshown in FIG. 12B) can be along an arm support integrated and/or coupledto the robotic arm that enables vertical translation of the robotic armalong the arm support. The second and third proximal axis can be 1292 aand 1292 b respectively. The three proximal axes can allow the system tobe positioned in the three-dimensional space and can allow translationof the robotic arm along the three-dimensional space.

The robotic arm can have three distal axes (1292 c, 1292 d, and 1292 e).The three distal axes can allow rotation of the robotic arm along thethree-dimensional space (e.g., pitch, yaw, and roll). In someembodiments, axes 1292 a, 1292 b, and 1292 c can comprise a planarSelective Compliance Articulating Robot Arm (SCARA) linkage. Theselective compliance can refer to the relation of the robotic arm'sstiffness in-plane vs. the robotic arm's stiffness out-of-plane. In someembodiments, axes 1292 a, 1292 b, and 1292 c move in the X-Y plane. Thiscan provide advantages such as an intuitive kinematic chain that can beeasily understood. Furthermore, movement with the X-Y plane can restrainthe motion of the robotic arm to a plane orthogonal to gravity. This inturn can eliminate the need for any counterbalancing or gravitycompensation.

In some embodiments, axes 1292 c, 1292 d, and 1292 e effectivelycomprise a three-axis gimbal capable of orienting the robotic arm aboutthree orthogonal axes of rotation. As seen in FIG. 12C, axis 1292 d canbe oriented very close to the center of mass 1293 of the robotic armthereby minimizing gravity torque and the need for a counterbalance. Ina similar manner, axis 1292 e can also be oriented very close to thecenter of mass 1293 of the robotic arm thereby minimizing gravity torqueand the need for a counterbalance.

In some embodiments, rotational constraint of the robotic arm can beachieved using at least one cross-roller bearing. The cross-rollerbearing can be capable of reacting to forces in the three linear degreesof freedom and torques in the two rotational degrees of freedom.Additionally, the cross-roller bearing can be free to rotate in thefinal rotational degree of freedom. In some embodiments, the jointsalong the axes 1292 a-1292 e can include the cross-roller bearings.Additionally, the joints along the axes 1292 a-1292 e can includefailsafe brakes.

FIG. 13A illustrates a first proximal axis of the robotic arm 1320(e.g., structurally and/or functionally similar to robotic arm 220 inFIG. 2 and/or robotic arm 320 in FIG. 3 ) along arm support 1310 (e.g.,structurally and/or functionally similar to arm support 210 in FIG. 2 )that enables vertical translation of the robotic arm along the armsupport 1310, in accordance with some embodiments. The robotic arm 1320can be coupled to or otherwise attached to manipulation device 1330(e.g., structurally and/or functionally similar to manipulation device230 in FIG. 2 ).

In some embodiments, the arm support 1310 along which the robotic armcan move linearly in a vertical direction can be coupled to, attachedto, or otherwise integrated with a base 1303 (e.g., structurally and/orfunctionally similar to base 203 in FIG. 2 ). The linear verticaltranslation provided by the first proximal axis can be counterbalancedwith a mass-over-pulley system illustrated in FIG. 13B. Themass-over-pulley system can include an upper pulley 1348 b and a lowerpulley 1348 a. The upper pulley 1384 b can include a fail-safe brake1383. The point of rotation of the upper pulley 1384 b can be point ofrotation 1382 b and the point of rotation of the lower pulley 1384 a canbe point of rotation 1382 a. A counterbalance can be connected with therobotic arm by a cable 1385 (e.g., wire rope and/or steel bands) overthe upper pulley 1384 b and the lower pulley 1384 a.

In some embodiments, the mass of the counterbalance can be equal to themass of the robotic arm, thereby balancing the moment load about theupper pulley 1384 b. As the robotic arm is raised or lowered, the changein potential energy of the robotic arm can be opposite to the change inpotential energy in the counterbalance. This can provide anenergy-neutral means to passive balancing. The direction of motion 1387can be vertical and parallel with gravity. This ensures a 1:1 potentialenergy transfer between the robotic arm and the counterbalance. Thefail-safe brake 1383 can hold the position of the arm support 1310. Thisbrake can be in a “hold” state when power is either off or lost, and ina “free” state when electrical voltage is applied to the fail-safe brake1383. The robotic arm motion can be constrained to move vertically witha pair of linear recirculating bearing rail (not shown in FIGS. 13A and13B).

FIG. 14 illustrates a manipulation device 1430 (e.g., structurallyand/or functionally similar to manipulation device 230 in FIG. 2 ),according to some embodiments. The manipulation device 1430 includes acatheter actuator 1434 a (e.g., structurally and/or functionally similarto catheter actuator 534 a in FIG. 5 ), a needle actuator 1434 b(e.g.,structurally and/or functionally similar to needle actuator 534 b inFIG. 5 ), and guidewire actuator 1434 c (e.g., structurally and/orfunctionally similar to guidewire actuator 534 c in FIG. 5 ). Themanipulation device 1430 can include an imaging device 1436 (e.g.,structurally and/or functionally similar to imaging device 536 in FIG. 5) that can provide a user with a visual aid of a vascular portion (e.g.,blood vessel) as the medical procedure is being performed.

In some embodiments, the imaging device 1436 can be an ultrasoundimaging device that captures a visual representation of a blood vessel.In some embodiments, the imaging device 1436 can be an ultrasound arraylocated on the manipulation device 1430. The ultrasound array canprovide two-dimensional ultrasound images along a longitudinal plane1443 b and a transverse plane 1443 a. FIG. 15 illustrates a traverseview 1543 a and a longitudinal view 1543 b of a blood vessel as capturedby an ultrasound imaging device (e.g., imaging device 1436 in FIG. 14 ).

As seen in FIG. 15 , the transverse view 1543 a of the blood vesselshows a radial cross section of the blood vessel while the longitudinalview 1543 b of the blood vessel shows an axial cross section of theblood vessel. As discussed above, the ultrasound array can provide avisual aid of the movement of the needle, catheter, and/or guidewireinto the blood vessel. Subsequent movement of the manipulation devicecan be controlled based on the feedback from the visual aid.

As the needle advances into the field of view of the ultrasound array,the tip of the needle may remain in a central longitudinal plane (e.g.,longitudinal plane 1443 b in FIG. 14 ) of the ultrasound array and themanipulation device because the ultrasound array and the manipulationdevice and/or the robotic arm are physically connected to each other.However, as the tip of the needle advances into the blood vessel, thetransverse plane of the needle may not remain in the transverse plane(e.g., transverse plane 1443 a in FIG. 14 ) of the ultrasound array.

In some embodiments, a position encoder on the needle actuator (e.g.,needle actuator 534 b in FIG. 5 ) and a limit switch can be used todetermine the absolute position of the needle tip. The absolute positionof the needle tip can be used to determine which transverse plane todisplay as a visual aid to the user.

FIGS. 16A-16D illustrate a change in the active transverse elements ofthe two-dimensional ultrasound array as the tip 1635 of the needleadvances into the blood vessel, in accordance with some embodiments. Thetransverse elements of the two-dimensional ultrasound array are shown inFIG. 16A. The transverse elements include elements in a first row 1673a, second row 1673 b, . . . nth row 1673 n. As seen in FIG. 16A, as theneedle is inserted into the blood vessel, the tip 1635 of the needle isunder the first row 1673 a of the transverse elements of thetwo-dimensional ultrasound array.

When the tip 1635 of the needle is under the first row 1673 a, thetransverse elements 1673 a′ and the longitudinal elements 1673 b′ of thetwo-dimensional ultrasound array seen in FIG. 16B become active. Thetransverse elements 1673 a′ and the longitudinal elements 1673 b′ emitand receive the ultrasound signals while the rest of the elements of thetwo-dimensional ultrasound array remain inactive.

As the needle advances into the blood vessel, for example, as the tip1635 of the needle advances from under the first row 1673 a to under theseventh row 1673 g of the transverse elements of the two-dimensionalultrasound array (shown in FIG. 16C), the row of the active transverseelements move. For example, as seen in FIG. 16D, the transverse elements1673 g′ become active (i.e., emit and receive ultrasound signals) whilethe rest of the transverse elements remain inactive. However, the activelongitudinal elements 1673 b′ remain the same. In this manner, thetransverse plane is updated as the tip of the needle advances into theblood vessel.

FIG. 17 illustrates a manipulation device 1730 (e.g., structurallyand/or functionally similar to manipulation device 230 in FIG. 2 and/ormanipulation device 530 in FIG. 5 ), according to some embodiments. Asdiscussed above, the manipulation device 1730 can include a portion ofone or more device actuator(s) that can be configured to actuate theneedle, the catheter, and/or the guidewire. In some embodiments, themanipulation device 1730 can include linear actuators that includemotors 1737, carriage blocks 1738, and ball screw 1739 to actuate theneedle, the catheter, and/or the guidewire. As seen in FIG. 17 , themanipulation device 1730 can include three linear actuators along threelinear axes to actuator each of the needle, the catheter, and/or theguidewire.

FIG. 18 is an illustration of a linear actuator within the manipulationdevice (e.g., structurally and/or functionally similar to manipulationdevice 230 in FIG. 2 and/or manipulation device 530 in FIG. 5 ), thatcan actuate the needle, the catheter, and/or the guidewire, inaccordance with some embodiments. As discussed above, the linearactuators can include a brushless DC motor 1837 fixed to a ball screwshaft 1839 supported by ball screw bearings 1847 and 1850. A magneticencoder 1841 coupled to the brushless DC motor 1837 can sinusoidallycommutate the brushless DC motor 1837. A linear circulating ball bearing1852 can be coupled to a ball screw nut 1848 that is fixed on the ballscrew shaft 1839. For instance, the linear circulating ball bearing 1852can be coupled to the ball screw nut 1848 on the ball screw shaft 1839via a carriage block 1838. As the ball screw shaft 1839 rotates (e.g.,owing to the rotation of the motor's rotor), the ball screw nut 1848translates as it is constrained by the linear circulating ball bearing1852 through the carriage block 1838. The translation of the ball screwnut 1848 can in turn actuate the needle, the catheter, and/or theguidewire along a linear axis.

In some embodiments, following the insertion of each of the needle, thecatheter, and/or the guidewire, a limit switch (not shown in FIG. 18 )can be triggered. An absolute position of the carriage block 1838 can bedetermined using the limit switch that is triggered each time the linearactuator returns to its home position. In some embodiments, a permanentelectromagnet 1851 can be fixed to the carriage block 1838. Thepermanent electromagnet 1851 in the carriage block 1838 can engage witha coupling element (e.g., puck) in the cartridge assembly, therebycoupling the cartridge assembly with the manipulation device.

FIG. 19A illustrates a cartridge assembly 1940 (e.g., structurallyand/or functionally similar to cartridge assembly 540 in FIG. 5 ), inaccordance with some embodiments. The cartridge assembly can include acatheter guide 1944 a (e.g., structurally and/or functionally similar tocatheter guide 544 a in FIG. 5 ), a needle guide 1944 b (e.g.,structurally and/or functionally similar to needle guide 544 b in FIG. 5), and a guidewire guide 1944 c (e.g., structurally and/or functionallysimilar to guidewire guide 544 c in FIG. 5 ) in a housing 1941. Each ofthe needle, catheter, and guidewire can be attached to a respectiveguide that guides them along the linear axis as they are actuated by thelinear actuators in the manipulation device. The needle, catheter, andthe guidewire can be moved along a respective linear axis relative tothe static housing 1941. FIG. 19B is an exploded view of the cartridgeassembly 1940 in FIG. 19A, in accordance with some embodiments.

FIGS. 20A and 20B illustrate attaching and/or coupling a cartridgeassembly 2040 (e.g., structurally and/or functionally similar tocartridge assembly 540 in FIG. 5 ) to a manipulation device 2030 (e.g.,structurally and/or functionally similar to manipulation device 230 inFIG. 2 and/or manipulation device 530 in FIG. 5 ), according to someembodiments. The cartridge assembly 2040 can be attached to themanipulation device 2030 by placing the cartridge assembly 2040 normalto the surface of the linear actuators (e.g., linear actuator 2034 a toactuate the catheter, linear actuator 2034 b to actuate the needle inFIG. 20A) in the manipulation device 2030.

In some embodiments, one or more mechanical engagement features betweenthe cartridge assembly 2040 and the manipulation device 2030 canmechanically couple the cartridge assembly 2040 to the manipulationdevice. For example, the housing of the cartridge assembly 2040 caninclude features such as tabs that fit within slots in the housing ofthe manipulation device 2030 as seen in FIG. 20B.

Additionally or alternatively, the catheter guide 2044 a, the needleguide 2044 b, and the guidewire guide 2044 c can each include a couplingelement such as a puck that comprises an injection molded plastic withan embedded steel disk. As discussed above, the carriage block in thelinear actuators in the manipulation device 2030 can include a permanentelectromagnet. The permanent electromagnet engages with a respectivepuck in the catheter guide, the needle guide, and the guidewire guide.The embedded steel disk in the puck can act as an armature to close themagnetic circuit in the permanent electromagnet, thereby engaging thecartridge assembly 2040 with the manipulation device 2030. This allowsthe pucks to be attached in both power-on and power-off scenarios,creating a fail-safe interface. Current can be applied to the permanentelectromagnet in order to release the puck.

FIG. 21A illustrates a puck with injection molded plastic 2157 thatincludes an embedded steel disk 2159. A guidewire guide 2144 c can beattached to the puck as seen in FIG. 21A. FIG. 21B illustrates acoupling between a manipulation device (e.g., structurally and/orfunctionally similar to manipulation device 230 in FIG. 2 and/ormanipulation device 530 in FIG. 5 ) and a cartridge assembly (e.g.,structurally and/or functionally similar to cartridge assembly 540 inFIG. 5 ), according to some embodiments. As seen in FIG. 21B, the puck2162 that includes the embedded steel disk 2163 is magnetically engagedwith the permanent electromagnet 2164. The lead-in chamber 2161 can aidin the kinematic alignment of the puck 2162 and the permanentelectromagnet 2164.

FIGS. 22A and 22B illustrate a mechanism to detect a coupling between apermanent electromagnet in a manipulation device (e.g., structurallyand/or functionally similar to manipulation device 230 in FIG. 2 and/ormanipulation device 530 in FIG. 5 ) and a puck in a cartridge assembly(e.g., structurally and/or functionally similar to cartridge assembly540 in FIG. 5 ), according to some embodiments. A carriage block (e.g.,structurally and/or functionally similar to carriage block 1738 in FIG.17 ) can include a plunger 2265 in a threaded housing 2266. A compressedspring 2267 can aid to the up and down movement of the plunger 2265. Theradially magnetized magnet 2268 (e.g., permanent magnet) can bepositioned above 2× Hall Effect sensors 2269. In FIG. 22A, the plunger2265 is in an “UP” position. When the magnet 2268 pulls in the magneticportion (e.g., embedded steel disk) in the puck of the cartridgeassembly, the plunger 2265 is forced down as shown in FIG. 22B. Thismoves the magnet 2268 closer to the 2× Hall Effect sensors 2269. The 2×Hall Effect sensors 2269 can measure the change in magnetic fieldintensity associated with the two positions of the plunger 2265.

FIGS. 23A and 23B illustrate the anatomical positioning of themanipulation device 2330 with respect to a blood vessel, in accordancewith some embodiments. As seen in FIGS. 23A an 23B, the manipulationdevice 2330 is positioned at an angle relative to the arm of a subject,and thereby at an angle relative to the blood vessel. For instance, themanipulation device can be at any suitable angle (e.g., angle betweenabout 20 degrees to about 60 degrees) relative to the blood vessel. Thecartridge 2340 can include the catheter along with needle and/orguidewire (e.g., 2936) to access the blood vessel based on the angle ofthe manipulation device 2330 relative to the arm of the subject

FIGS. 24A-24F illustrate the steps of the Seldinger technique performedusing the manipulation device (e.g., structurally and/or functionallysimilar to manipulation device 230 in FIG. 2 and/or manipulation device530 in FIG. 5 ) and the cartridge assembly (e.g., structurally and/orfunctionally similar to cartridge assembly 540 in FIG. 5 ) describedherein.

As shown in FIG. 24A, the first step involves aligning a needle end witha catheter tip. FIG. 24A shows a needle guide 2444 b that is tangent toan internal catheter bore and a needle tip 2435 that is outside thecatheter lumen. In FIG. 24B, the needle tip 2435 is inserted into anartery 2471. As discussed above, as the needle tip advances into thefield of view of an imaging device such as an ultrasound array, theneedle tip will remain the longitudinal plane as the ultrasound array.However, the transverse plane of the needle tip changes as the needleadvances.

In FIG. 24C, the guidewire is advanced into the artery 2471. The needleguide and the catheter guide can be held stationary when the guidewireis inserted. If the guidewire is visible in an imaging device such as anultrasound array, the transverse plane can be updated in a mannersimilar to the needle tip in order to visualize the guidewire.

In FIG. 24D, the catheter is advanced into the artery 2471. In FIG. 24E,the needle and the guidewire are retracted. In FIG. 24F, the permanentelectromagnet in the carriage block included in the linear actuator thatactuates the catheter can be energized in order to release the catheterfrom the manipulation device. In some embodiments, the catheter mayinclude a hole on the top of the catheter to prevent blood from comingout. As an alternative step to FIG. 24F, the user can manually detachthe catheter from the catheter guide instead of energizing the permanentelectromagnet. FIG. 25 is a table illustrating the states of the needleactuator, catheter actuator, and guidewire actuator for the Seldingertechnique.

FIG. 26 illustrates another variation of a manipulation device 2630(e.g., structurally and/or functionally similar to manipulation device230 in FIG. 2 and/or manipulation device 530 in FIG. 5 ), in accordancewith some embodiments. As seen in FIG. 26 , the linear actuators (e.g.,motors) for the guidewire and the needle, that is, motor 2634 b andmotor 2634 c respectively, can be combined to be on a same ball screwshaft. The motor 2634 a for the catheter is on a different ball screwshaft. Such an embodiment results in a more compact size, and allows thecartridge assembly to mount to a vertical face as opposed to the bottomface of the manipulation device 2630. Mounting the cartridge assembly tothe vertical face gives the user better access to the cartridgeassembly. FIGS. 27A and 27B illustrate different views of themanipulation device 2630 in FIG. 26 , in accordance with someembodiments.

FIG. 28 is an illustration of a linear actuator within the manipulationdevice 2630 in FIG. 26 (e.g., structurally and/or functionally similarto manipulation device 230 in FIG. 2 and/or manipulation device 530 inFIG. 5 ), that can actuate the needle, the catheter, and/or theguidewire, in accordance with some embodiments. The linear actuatorincludes a control unit 2861. The control unit 2861 can include motorprotection algorithm, 3× Hall effect sensors, encoder chip, andoptionally a thermistor. The actuator includes two radial bearings 2866and 2862. The encoder disk 2867 is positioned to align with the 3× Halleffect sensors in the control unit 2861. The linear actuator alsoincludes ball screw nut 2863, motor stator 2864, and motor rotor 2865.In contrast to the linear actuator(s) described above, the ball screwshaft is not fixed to the housing of the manipulation device and doesnot rotate. Instead, the ball screw nut 2863 mounted on the motor rotor2865 rotates along with the motor rotor.

FIGS. 29A and 29B are an illustration of a cartridge assembly thatattaches to the manipulation device in FIG. 26 , in accordance with someembodiments. FIGS. 29A and 29B show the needle guide 2944 b and theguidewire guide 2944 c that guide the needle and guidewire respectivelyon a single linear axis. The catheter guide 2944 a is on a separatelinear axis. The cartridge assembly in FIGS. 29A and 29B are of a morecompact size than that depicted in FIGS. 19A-19B.

While various inventive embodiments have been described and illustratedherein, those of ordinary skill in the art will readily envision avariety of other means and/or structures for performing the functionand/or obtaining the results and/or one or more of the advantagesdescribed herein, and each of such variations and/or modifications isdeemed to be within the scope of the inventive embodiments describedherein. More generally, those skilled in the art will readily appreciatethat all parameters, dimensions, materials, and configurations describedherein are meant to be exemplary and that the actual parameters,dimensions, materials, and/or configurations will depend upon thespecific application or applications for which the inventive teachingsis/are used. Those skilled in the art will recognize, or be able toascertain using no more than routine experimentation, many equivalentsto the specific inventive embodiments described herein. It is,therefore, to be understood that the foregoing embodiments are presentedby way of example only and that, within the scope of the appended claimsand equivalents thereto; inventive embodiments may be practicedotherwise than as specifically described and claimed. Inventiveembodiments of the present disclosure are directed to each individualfeature, system, article, material, kit, and/or method described herein.In addition, any combination of two or more such features, systems,articles, materials, kits, and/or methods, if such features, systems,articles, materials, kits, and/or methods are not mutually inconsistent,is included within the inventive scope of the present disclosure.

Also, various inventive concepts may be embodied as one or more methods,of which an example has been provided. The acts performed as part of themethod may be ordered in any suitable way. Accordingly, embodiments maybe constructed in which acts are performed in an order different thanillustrated, which may include performing some acts simultaneously, eventhough shown as sequential acts in illustrative embodiments.

Some embodiments and/or methods described herein can be performed by adifferent software (executed on hardware), hardware, or a combinationthereof. Hardware modules may include, for example, a general-purposeprocessor, a field programmable gate array (FPGA), and/or an applicationspecific integrated circuit (ASIC). Software modules (executed onhardware) can be expressed in a variety of software languages (e.g.,computer code), including C, C++, Java™, Ruby, Visual Basic™, and/orother object-oriented, procedural, or other programming language anddevelopment tools. Examples of computer code include, but are notlimited to, micro-code or micro-instructions, machine instructions, suchas produced by a compiler, code used to produce a web service, and filescontaining higher-level instructions that are executed by a computerusing an interpreter. For example, embodiments may be implemented usingimperative programming languages (e.g., C, Fortran, etc.), functionalprogramming languages (Haskell, Erlang, etc.), logical programminglanguages (e.g., Prolog), object-oriented programming languages (e.g.,Java, C++, etc.) or other suitable programming languages and/ordevelopment tools. Additional examples of computer code include, but arenot limited to, control signals, encrypted code, and compressed code.

It will be understood that, although the terms first, second, third,etc. may be used herein to describe various elements, these elementsshould not be limited by these terms. These terms are only used todistinguish one element from another element. Thus, a first elementdiscussed below could be termed a second element without departing fromthe teachings of the present disclosure.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting. As used herein, thesingular forms “a”, “an”, and “the” are intended to include the pluralforms as well, unless the context clearly indicates otherwise. It willbe further understood that the terms “comprises” and/or “comprising” or“includes” and/or “including” when used in this specification, specifythe presence of stated features, regions, integers, steps, operations,elements, and/or components, but do not preclude the presence oraddition of one or more other features, regions, integers, steps,operations, elements, components, and/or groups thereof.

1. An apparatus, comprising: a cart movable from a first location to asecond location near a patient, the cart having a platform and avertical adjustment element configured to adjust a distance between theplatform and a ground supporting the cart; a cartridge including aneedle, a catheter, and a guidewire, each of the needle, the catheter,and the guidewire being disposed linearly within a housing and coaxiallyrelative to one another; a manipulation device configured to releasablycouple to the cartridge; a plurality of actuators each configured tocouple to a different one of the needle, the catheter, and the guidewireto selectively advance the needle, the catheter, and the guidewire, whenthe manipulation device is coupled to the cartridge; and a robotic armhaving a first end mounted to the platform and a second end coupled tothe manipulation device, the robotic arm having a plurality of segmentsjoined together via a plurality of joints such that the robotic arm canbe moved to position the needle, the catheter, and the guidewire forinsertion into a target vessel.
 2. The apparatus of claim 1, furthercomprising an imaging system coupled to a distal end portion of themanipulation device, the imaging system configured to capture atransverse view and a longitudinal view each including the targetvessel.
 3. The apparatus of claim 2, wherein the imaging system isconfigured to change the transverse view as a tip of the needle isadvanced into the target vessel to show the transverse view thatcorresponds to a transverse plane of the tip of the needle.
 4. Theapparatus of claim 2, wherein the imaging system includes an ultrasoundarray.
 5. The apparatus of claim 1, wherein the manipulation deviceincludes a coupling mechanism coupled to one of the plurality ofactuators, the coupling mechanism configured to releasably couple to acoupling element in the cartridge that is coupled to at least one of theneedle, the catheter, or the guidewire, such that, upon the couplingmechanism being coupled to the coupling element, movement of theactuator causes a respective movement of the at least one of the needle,the catheter, and the guidewire.
 6. The apparatus of claim 5, whereinthe coupling mechanism includes at least one magnet, and the couplingelement includes at least one magnetic element, the at least one magnetbeing configured to magnetically couple to the at least one magneticelement.
 7. The apparatus of claim 5, wherein the manipulation deviceincludes at least one sensor to detect the coupling between the couplingmechanism of the manipulation device and the coupling element in thecartridge.
 8. The apparatus of claim 7, wherein the at least one sensorincludes a Hall Effect sensor, and the manipulation device furtherincludes a permanent magnet that is configured to displace in responseto the coupling between the coupling mechanism and the coupling element,the Hall Effect sensor configured to measure a change in a magneticfield intensity caused by the movement of the permanent magnet.
 9. Theapparatus of claim 1, wherein the manipulation device is pivotablysupported by a joint of the plurality of joints with respect to adistalmost segment of the robotic arm such that an angle of insertion ofthe needle, the catheter, and the guidewire into the target vessel canbe adjusted via the joint.
 10. The apparatus of claim 9, wherein acenter of mass of the manipulation device is disposed near the joint toreduce torque due to gravity on the joint.
 11. The apparatus of claim 1,wherein each joint of the plurality of joints of the robotic armincludes a failsafe brake configured to lock movement about the jointuntil electrically released.
 12. The apparatus of claim 1, furthercomprising: an imaging system configured to capture a view including atleast a part of the manipulating device and a portion of the patientincluding the target vessel; and a communication interface configured tosend image data of the view to a remote compute device such that aposition of the cartridge relative to the portion of the patient can beconfirmed by a user at the remote compute device. 13.-30. (canceled) 31.The apparatus of claim 1, wherein each of the guidewire, the needle, andthe catheter is coupled to a guide of a plurality of guides, each of theplurality of actuators configured to couple to a different guide of theplurality of guides.
 32. The apparatus of claim 31, wherein themanipulation device includes a plurality of recessed portions, eachrecessed portion of the plurality of recessed portions being configuredto receive a respective guide member of the plurality of guides.
 33. Theapparatus of claim 1, wherein the plurality of actuators include: afirst linear actuator configured to linearly advance and retract theguidewire; a second linear actuator configured to linearly advance andretract the needle; and a third linear actuator configured to linearlyadvance and retract the catheter.
 34. The apparatus of claim 33, whereinat least two of the first, second, and third linear actuators aredisposed parallel to one another.
 35. The apparatus of claim 33, whereineach of the first, second, and third linear actuators includes: a screwshaft, and ball screw nut configured to linearly advance along the screwshaft in response to a rotation of the screw shaft.
 36. The apparatus ofclaim 1, wherein each actuator of the plurality of actuators includes amagnet configured to magnetically couple that actuator with a respectiveone of the needle, the catheter, and the guidewire.
 37. The apparatus ofclaim 1, wherein at least one actuator of the plurality of actuatorsincludes a sensor configured to detect a coupling between that actuatorand a respective one of the needle, the catheter, and the guidewire. 38.(canceled)
 39. The apparatus of claim 1, wherein the cartridge isconfigured to house the at least the portion of the guidewire in alinear state.
 40. The apparatus of claim 1, wherein the cartridgefurther includes: a first guide coupled to the guidewire and configuredto couple to a first actuator of the plurality of actuators; a secondguide coupled to the needle and configured to couple to a secondactuator of the plurality of actuators; and a third guide releasablycoupled to the catheter and configured to couple to a third actuator ofthe plurality of actuators.
 41. The apparatus of claim 1, wherein themanipulation device includes a plurality of motors coupled to theplurality of actuators, the plurality of motors configured to rotate todrive the plurality of actuators.
 42. The apparatus of claim 1, whereinthe manipulation assembly includes a housing that houses the pluralityof actuators.
 43. The apparatus of claim 1, wherein the platformincludes a surface for mounting the robotic arm and for supporting anarm of the patient.
 44. The apparatus of claim 2, wherein the imagingdevice and the manipulator device are fixedly coupled.